Chapter 165 The cause of the disease is found, but medication is difficult
Dr. Chi didn't take it too seriously at first because Zhou Can was just a resident intern.
He thought that a doctor from the critical care unit had sent Zhou Can over to learn about the patient's diagnosis and treatment.
"Examination of the patient revealed intestinal bleeding. Can you describe the details?"
"We performed angiography on the patient, and found that the bleeding was mainly concentrated in the colon segment of the large intestine. There were multiple and diffuse bleedings," said Dr. Xia Ping, describing the situation at the time.
He is the treating physician and the patient's attending physician, and knows the patient's condition best.
Diffuse hemorrhage is usually the most dangerous when it occurs within the brain.
It spreads the bleeding area like smoke. It often refers to bleeding at multiple points at the same time, which is more common in chronic cases. This type of bleeding is often related to superficial capillary lesions or dilation. Another common cause is sepsis.
"What about other sections of the intestine? Is there any bleeding?"
Zhou Can continued to ask.
I gained a lot from making this call.
At least I have asked him the preliminary questions he wanted to know.
"There was almost no bleeding in the cecum, but there was a little bleeding in the rectum. No bleeding was found in the anorectum either. Later, unable to resist the family's repeated requests, I took the risk of performing a colonoscopy on the patient. Consistent with the results of the angiography, the bleeding was mainly concentrated in the colon segment. There was also a small amount of bleeding in the rectum. Thrombin treatment and cryotherapy were not effective."
"Through observation and comparison, I also found that the bleeding points found during endoscopy were in different locations from those found during angiography. I am sure that the bleeding points of patients are constantly changing."
Doctor Xia recounted all his findings.
After hearing this, Zhou Can became more convinced that there was something wrong with his small intestine.
The details I learned from Xia Ping are so precious.
"Do you think it's possible that the malignant tumor has infiltrated the intestinal wall and caused bleeding?"
Zhou Can was doing the final elimination.
If malignancy could also be ruled out, then he could narrow the diagnosis even further.
"The possibility of malignant tumors is extremely small. At least colon cancer and rectal cancer can be basically ruled out."
Xia Ping is quite conservative in his speech.
This is also a skill of speaking that experienced doctors have developed while being forced to practice during various beatings.
Only a doctor who is truly capable and has complete confidence in the field in which he is extremely proficient would dare to speak with certainty.
Otherwise, it’s usually a speech technique that can be used to retreat or advance.
"Doctor Zhou, who is your superior doctor? Did he ask you to come and inquire about the patient's condition?" Xia Ping seemed to hear something wrong and began to interrogate Zhou Can in return.
"My superior doctor is Hu Yiba from the Department of Critical Care Medicine. Doctor Hu is not aware of this matter. I just wanted to know about the patient's condition, so I took the liberty to bother you."
Zhou Can didn't dare to speak nonsense.
Many doctors in the hospital know each other, so if there is anything, they can tell whether it is true or not just by asking.
He would never dare to bear the charge of dishonesty.
"So that's how it is! I'm busy here. If there's nothing else, let's talk about this!" When Xia Ping heard that it was Zhou Can's own idea, his attitude immediately turned much colder.
Senior doctors often encounter newbies like Zhou Can who ask all kinds of questions.
Like a curious baby, he always asks senior doctors all kinds of questions.
Senior doctors may be a little patient with the junior doctors they are responsible for teaching, but this is basically the attitude they have towards junior doctors who have nothing to do with them.
“Can you also describe the specific treatment you performed on the patient?”
Zhou Can wanted to know more.
In particular, the treatment methods used by the treating physician, the effects of the treatment, and the reactions of the patients.
These data are extremely valuable and can help him better diagnose the cause of the patient's illness.
Why is it difficult to diagnose some difficult and complicated diseases?
Because all the common causes have been ruled out, the doctor needs to try it himself, like a pony crossing a river, to find a path that no one has ever walked before.
"You can check the medical records for specific treatments you've received. I have something to do here. Bye."
After that, Zhou Can didn't wait for anything else to say.
The person on the other end of the line hung up immediately, and a busy tone was heard, ending the call.
Dr. Xia is really realistic.
Zhou Can was speechless for a while.
Fortunately, I have obtained a lot of key information, so this trip was quite fruitful.
"It's a good thing for new doctors to be diligent in learning and asking questions, but they should be moderate. Our attending physicians are often very busy, and few are willing to spend their spare time answering random questions."
What Dr. Chi said to Zhou Can was more of a warning.
There's no malice involved.
I just told Zhou Can not to be so reckless next time. It is very annoying to disturb the senior doctor casually.
Zhou Can didn't argue with him.
Instead, he thanked him and left quickly.
It has now been basically determined that the patient's lesion is in the small intestine.
As for the specific cause of the disease, after eliminating them one by one, a light bulb suddenly flashed in his mind.
Could it be a parasite? And this parasite is not in the large intestine, but in the small intestine.
[Pathological diagnosis experience value +1. ]
The experience points have been credited, which shows that his diagnosis was correct.
To get a final diagnosis, the patient needs further examination.
Zhou Can was excited.
Hard work pays off, and the diagnosis of this patient finally took a big step forward.
At this point, the cause of the disease has been basically determined.
The patient had a parasite in his small intestine.
As for how the evil is done, it can be further analyzed.
The patient's stool has been routinely tested, and if there are parasites, they can usually be found. At least eggs can be found.
However, if no parasites or worm eggs were found during a routine stool test, it means that the parasites are likely hiding in the small intestine, madly absorbing the patient's nutrients and producing substances that can cause bleeding in the large intestine.
It could be larvae, or it could be some hormone or harmful substance that can stimulate intestinal bleeding.
Considering that the patient had diffuse bleeding, which was concentrated in the colon segment.
Zhou Can is more inclined to believe that the parasites lurk in the small intestine, absorb the nutrients they need from the intestinal fluid, and then excrete irritating and harmful substances that can cause bleeding in the large intestine.
After the small intestinal fluid enters the large intestine, the cecum segment is very short and its function is similar to that of the small intestine, so it mainly absorbs nutrients and impurities that are not absorbed by the small intestine.
Those small intestinal fluids stay in the cecum for a shorter time.
On the contrary, the colon is 1.1 meters long. When food passes through the stomach and small intestine and reaches the colon, it secretes some alkaline substances to protect the intestinal mucosa and lubricate the intestines. At the same time, it absorbs electrolytes such as water and sodium.
After food residues reach the colon, they are absorbed by water and slowly form stool.
As the colon continues to move, stool is discharged into the rectum.
Eventually it is discharged from the body through the anorectal and anus.
From this we can see that the fluid discharged from the small intestine stays in the colon segment the longest.
And it also has the process of changing feces from liquid to solid.
During this process, harmful substances that can cause intestinal bleeding are absorbed by the intestinal wall, causing capillary dilation and diffuse bleeding.
At this point, the diagnostic ideas are already very clear and definite.
That harmful substance can cause capillary dilation in the large intestine.
Maybe because the irritation is not particularly strong, it only causes mild chronic bleeding.
[Congratulations on successfully diagnosing a very difficult case. Pathology diagnosis experience points +100. ]
At this moment, the truth is revealed to the world.
Zhou Can clenched his fists tightly and raised his arms.
I feel extremely excited.
Not only did he receive a reward of 100 pathology diagnosis experience points, but he also saved a life.
This is such a meaningful thing to do.
Since it has been confirmed that it is a parasite and is causing trouble in the small intestine, taking anthelmintics should be able to quickly stop the gastrointestinal bleeding of the patient in bed 7.
Although the cause of the disease has now been clearly diagnosed, how to convince senior doctors is still a problem.
The senior doctor was extremely cautious in using the medicine. The patient was already extremely weak. If something happened, no one could take the responsibility.
He decided to call his superior doctor Hu Yiba first.
When he first entered the Department of Critical Care Medicine, Zhou Can was only slightly familiar with Hu Yiba.
I took out my cell phone, luckily I had saved Hu Yiba's phone number when I got off work.
Just call.
After two rings, the call was connected.
"Who?"
It seems that Dr. Hu did not save his number.
This also shows that doctors actually look down on those who have connections with others.
Zhou Can is much better than those people who have connections but no ability.
At least he was cultivated by Vice President Ye based on his strength.
But in Dr. Hu's eyes, the status is still very low.
"Hello, Doctor Hu. I am Zhou Can, the resident trainee who was just assigned to work under you today."
Zhou Can introduced his name in a very humble manner.
"Oh! It's Xiao Zhou, what's up?"
Dr. Hu's attitude remained gentle.
"After careful analysis and consultation with my superiors, I seem to have found the cause of the bleeding in bed No. 7."
Zhou Can knew that his qualifications were shallow, and it would be difficult to convince Dr. Hu unless he used two fictitious senior doctors as cover.
"Haha, you found the cause of the bleeding so quickly? Tell me about it."
Dr. Hu obviously didn't take it seriously.
Some even felt that Zhou Can was a little eager for quick success, and was thinking about making a contribution as soon as he entered the Department of Critical Care Medicine.
The patient in bed 7 was examined by several doctors in the Department of Gastroenterology, including the chief physician. After being admitted to the ICU, Dr. Hu, Dr. Shi, and the chief physician of the department all understood the patient's condition.
So many people have come here but no one has found the cause of the bleeding.
On the first day Zhou Can arrived at the Department of Critical Care Medicine, he was told that the cause of the patient's bleeding had been found.
Dr. Hu only felt that the young man was somewhat naive and superficial.
Of course, he wouldn't point it out to her face.
"I consulted Dr. Xia, the attending physician of this patient, and learned about the situation. The patient mainly had diffuse and widespread bleeding of unknown cause in the colon segment. The bleeding point was different each time. Various common gastrointestinal bleeding diseases can be ruled out. After dialectical analysis, we believe that the patient's real lesion is likely in the small intestine. And it is possible that the excrement of the parasite caused the telangiectasia of the inner wall of the large intestine, which eventually caused the bleeding..."
Zhou Can could naturally tell that Dr. Hu did not take his diagnosis seriously.
He still tried to explain his diagnostic ideas.
He even told Dr. Xia about it.
"Yes! I will take your diagnosis seriously. It's already off work now. If you have any questions, we can discuss them tomorrow at work!"
What Dr. Hu said is pure cliché.
Most of the work is done in a perfunctory manner.
"The patient's condition is critical. If he can be diagnosed early and treated with medication, it will definitely be of great significance. Do you think we can handle it today?"
Zhou Can asked with gritted teeth.
Judging from Dr. Hu’s tone, he definitely didn’t take it seriously.
The cause of the disease was finally diagnosed, but the senior doctor did not trust it and follow-up treatment could not be implemented.
This made Zhou Can extremely unwilling.
The rewards from the experience system have already been paid, so his diagnosis must be correct.
I didn't expect to get stuck at the senior doctor's level.
"Xiao Zhou, newcomers should avoid being too eager for quick success and should be more calm. Every patient in the ICU is in critical condition. According to what you said, they may need to use insecticides. All insecticides are sprays and will have certain effects on the body. Normal people can tolerate them and may not even notice any symptoms. But for critically ill patients, even the slightest adverse effect on the body may be magnified many times."
"You said that parasites were causing trouble in the small intestine. You can't just make inferences! There must be scientific evidence for the diagnosis. It is extremely irresponsible to use insecticides on critically ill patients based on inferences alone. No doctor can afford the possible adverse consequences."
Dr. Hu criticized him very tactfully.
These words all make sense.
That's the truth.
But doing everything according to rules and procedures is a bit dogmatic.
This arbitrary approach will definitely delay the patient's treatment.
"Of course, your spirit of daring to explore and diligently studying is very worthy of encouragement. We will discuss the diagnosis and treatment of the patient in bed 7 tomorrow. Now all the regular departments of the hospital are off work and cannot carry out work. Go to bed early!"
After saying that, Dr. Hu hung up the phone.
Zhou Can stood there in a daze.
Full of joy and excitement, but then a bucket of cold water was poured over my head.
He took two deep breaths, adjusted his mood, and decided not to turn back until he hit the wall.
Go directly to the duty room of the intensive care unit to find the taciturn Dr. Shi.
It takes tremendous courage to do this.
Because in the end it is very likely that nothing will be done and you will end up with nothing.
People need face and trees need bark.
I believe no doctor would be willing to do such a thankless task after being constantly rejected and criticized by senior doctors.
Zhou Can has always been a little "stupid" when it comes to treating patients.
He walked straight to the door of the intensive care unit.
Ring the doorbell.
The door opened quickly.
A nurse stood inside.
Looks quite familiar.
Nurses in intensive care units work 12-hour shifts, but in reality, they often have to work more than 13 hours.
Zhou Can got off work, but the nurse did not take over.
"Doctor Zhou, aren't you off work? Did you forget something?"
The nurse asked him with a smile.
"I want to talk to Dr. Shi about the patient in bed 7."
Zhou Can walked straight in.
"Doctor Shi is in the duty room. Just change your clothes and go find him."
"Thanks."
Zhou Can changed into isolation clothing and walked into the duty room.
Several doctors and nurses were discussing the patient's treatment and condition. Dr. Shi seemed to be writing medical advice to the patient, working on the computer, and occasionally frowning in thought.
Zhou Can entered the duty room without attracting much attention from other medical staff.
"Doctor Shi, can I bother you for a moment?"
Zhou Can walked up to Dr. Shi and greeted him.
Dr. Shi looked up at him and recognized him.
"Aren't you the resident trainee under Dr. Hu? What do you want from me?"
There was no smile on his face and his tone was quite cold.
Zhou Can gritted his teeth and told the story of the patient in bed 7.
Doctor Shi had been listening silently, with his facial expression not changing much.
The trainee sitting next to him showed a barely perceptible disdain at the corner of his mouth. He probably thought Zhou Can was just looking for trouble.
After listening to Zhou Can's story, Dr. Shi's expression did not change much.
His eyes were still cold and his face was serious.
Zhou Can was standing nearby, feeling very nervous. If Dr. Shi still did not take his diagnosis seriously, he would probably have to wait until tomorrow to try to convince Dr. Hu.
The cause of the disease was diagnosed, but treating the patient became the biggest challenge.
No doctor would dare to take this risk.
And there is really no basis for inspection.
Doctor Shi thought for a moment without saying a word, and then continued to operate the computer and write medical prescriptions for the patient.
Zhou Can stood there, looking very embarrassed.
It's not right to leave, but it would be more awkward not to leave.
It seemed that Dr. Shi ignored him.
After seven or eight minutes, Dr. Shi finally finished writing the medical instructions.
This period of waiting was really a torment for Zhou Can. The strange looks from other doctors and nurses from time to time made him feel even more uncomfortable.
It felt like a clown standing there being stared at.
"You came up with these diagnoses ?"
It turned out that Dr. Shi had not forgotten him. He turned slightly and looked up into Zhou Can's eyes.
"yes!"
Zhou Can couldn't lie because the other person's eyes seemed to be able to see through people's hearts.
It would be even more difficult if we were not honest.
The best thing to do is to just admit it.
"I knew you came up with this by yourself. Why did you have to involve a nonexistent senior doctor? Experienced senior doctors always make careful decisions step by step, and each step is based on examination data or symptoms. Your diagnostic thinking is more like a wild imagination, like a child's scribbling."
Doctor Shi looked taciturn, but I didn't expect him to have such abnormal insight.
Zhou Can broke out in a cold sweat on his back.
"But it is your alternative thinking of breaking the rules and escaping the constraints that gives me a glimmer of hope. I urgently need to go in and treat the patient. I will be out in about half an hour to an hour. If you are willing, you can wait here for me, and then I will discuss the patient in bed 7 with you."
Dr. Shi said.
