Chapter 264: A diagnosis that is like peeling off the silk thread, misfortune only finds the unfortunate
After the patient left, Director Zheng stood up and held Zhou Can's hand tightly.
"Dr. Zhou, thank you for coming to help! This case is very difficult to diagnose. When the results of the small intestinal perfusion test come out, I will need your continued help in the diagnosis."
Zheng Hongtao treated Zhou Can with such courtesy because the diagnosis of this disease required a lot of reliance on Zhou Can.
There are also diseases that cannot be cured by large hospitals outside. If he can crack the problem and cure the patients, it will be of great benefit to him.
The authority and reputation of an expert are built up bit by bit through treating difficult cases in related fields and publishing high-level papers with great influence.
A nine-story tower is built from piled earth, and a tree that can be embraced by two people grows from a tiny seed.
Famous doctors never become famous overnight.
Those who become famous based on one or two cases and are called "miracle doctors" are mostly "quack miracle doctors". Most of them are fraudsters, and there is no real miracle doctor.
Patients travel thousands of miles to seek medical treatment, but what they pay is nothing more than an IQ tax.
Of course, there is a kind of miracle doctor who may have real skills. They are some hidden Chinese medicine practitioners who may not have a medical license, may be cynical, and may look more like a charlatan.
However, they have mastered some lost traditional Chinese medical skills and can actually relieve patients' suffering.
Moreover, there is an essential difference between this kind of miracle doctor and charlatans.
They treat patients not for the purpose of making money, but charge low fees. They may even do nothing for poor patients, just like the ancient Chinese medicine practitioners. They lose money by treating patients, just to help them get rid of their pain.
Charlatans use all kinds of tricks and scams, such as "curing diseases with qigong" or a certain folk remedy that can cure all diseases and so on.
All of these, without exception, are just tricks to make people pay the IQ tax.
Even if the patients feel that they are better after the treatment, it is actually just a psychological effect.
From a medical perspective, those medicines that claim to cure all diseases are, without exception, all fake drugs, health products, and are designed to deceive people into paying the IQ tax.
From Zhou Can's professional perspective, drugs that can truly cure diseases all have strong toxic side effects.
They can only treat a small group of diseases, not a cure-all.
Most of these drugs are prescription drugs, which are difficult for patients to buy themselves.
When doctors prescribe medicine, they also need to think twice and consider everything before writing out the prescription.
After Zhou Can came back from the outpatient department, he went back to the office to write medical records, medical history, and check doctor's orders.
As he became more and more proficient in writing prescriptions independently, he clearly felt that his experience and knowledge reserves were insufficient. In addition to increasing the frequency of consulting senior doctors, he thought of many other ways to quickly improve his prescription writing skills.
I will definitely read hard every day and greedily supplement my basic medical knowledge.
Another way is to use the authority to look through the past treatment cases in the department, to look at the medical orders issued by Director Shang, Director Zheng, Deputy Director Shi and others, and learn from their experience.
This is a very good idea.
You can gain 1 point of pharmacological differentiation experience and 1 point of pathological diagnosis experience for each case you see.
It can be said to kill two birds with one stone.
At about 6pm, the patient with diarrhea and diabetes insipidus finished the small intestinal perfusion test, and his family members took the results to find Director Zheng Hongtao. Then Director Zheng took the results directly to the office to find Zhou Can.
After all, he is a chief physician. It is somewhat embarrassing for him to ask Zhou Can for help again and again in front of the family members.
So he sent his family back and went to see Zhou Can alone with the test results.
The analysis and diagnosis of such difficult cases is extremely difficult.
He went to discuss it with Zhou Can, and the doctors didn't make fun of him.
Besides, there are many doctors who come to Zhou Can for help all day long.
Now even the young nurses in the department are looking for Zhou Can for help one by one.
For example, when intubating a patient or performing intravenous indwelling, it is difficult to find the blood vessels of some obese patients.
They all came to Zhou Can for help.
The pretty young nurse in her twenties kept calling him Brother Can, and Zhou Can really couldn't bear to refuse.
Unless I'm extremely busy, I'll go over and help them.
You can earn experience points and gain their gratitude, so why not do it!
Especially for operations like urinary catheterization and tracheal intubation, you can earn 1 insertion experience point for each completed operation. If you are lucky, you may even get an additional bonus of 10 insertion experience points.
"Doctor Zhou, according to the small intestinal perfusion test, it is proved that the patient has a large amount of water and electrolyte secretion in the intestine. It can be preliminarily diagnosed as secretory diarrhea."
Zheng Hongtao showed him the test results.
The patient also underwent stool examination and bacterial culture, the results were negative.
This can rule out the possibility of chronic intestinal bacterial inflammation.
There are four common types of diarrhea: secretory diarrhea, osmotic diarrhea, exudative diarrhea, and abnormal diarrhea caused by gastrointestinal dysfunction.
Among them, exudative diarrhea is actually what is commonly known as inflammatory diarrhea.
For example, enteritis.
Therefore, routine stool tests and bacterial culture are very important for diagnosis. If the result of bacterial culture is negative, exudative diarrhea can be directly ruled out.
Small intestinal perfusion helps them to directly identify patients with secretory diarrhea.
"The patient's stool routine showed that the potassium, sodium, chloride, and bicarbonate excretions were all seriously above normal values. The highest was even twenty times higher than normal. No wonder the patient's body couldn't handle it."
Zhou Can really sympathized with this patient. He had been suffering from diarrhea for so many days. If it were an ordinary person, he would have suffered from rectal prolapse long ago.
"If the young man wasn't in his twenties, which is the age when his body is at its strongest, he would have been admitted to the intensive care unit. Now that the type of diarrhea has been basically determined, the next step is to find out the cause of the diarrhea. Does Doctor Zhou have any advice?"
When Director Zheng and Zhou Canji discussed the patient's condition, they spoke in a completely equal tone.
The reason why this patient's disease is difficult to treat is that every diagnostic approach is blocked by invisible walls.
For example, hypokalemia was found and it was known to be caused by alkalosis, but it was difficult to make further breakthroughs after this step.
Now we have changed the diagnosis direction and directly checked for diarrhea. We did a small intestinal perfusion test and routine stool test and confirmed that it was secretory diarrhea. However, the cause of the diarrhea is still confusing.
There are many causes of secretory diarrhea.
This requires Zhou Can to clear away the layers of fog and separate the truth from the false.
The reason why pathological diagnosis is difficult is that when encountering some complex diseases, the real cause is as hidden as the answer to a word problem. Only by solving it step by step can we finally find the correct answer.
Zhou Can's mind quickly flashed through the causes of secretory diarrhea.
Cholera is a notorious Class A infectious disease that has claimed countless lives in ancient times.
Even today when medical technology is highly developed, cholera is still a dangerous disease.
The patient had diarrhea that lasted for several days, and the symptoms were consistent with cholera.
The second disease that comes to mind is pancreatic endocrine tumors. Pancreatic cancer is not called the king of cancer for nothing. The unexplained diarrhea it causes can cause the patient to have severe anal prolapse, to the point where even plugs can't be inserted.
During his training in the Department of Critical Care Medicine , Zhou Can witnessed with his own eyes a patient whose intestines were pulled out.
The third thing that comes to mind is carcinoid syndrome. The diarrhea caused by this disease is also related to cancer.
From this we can see that if someone has diarrhea for a long time, they must go to the hospital for a check-up, because this kind of long-term diarrhea is very related to cancer.
All cancers are best treated if they are diagnosed early.
In some developed countries, the incidence of cancer is actually very high.
However, they pay great attention to physical examinations, and their consumption concept is completely different from the simple and frugal Chinese people. When they have money, they think about traveling and buying things that interest them.
In their eyes, advance consumption and overdraft consumption are just normal little things.
Even if the Chinese people have some pain or itching in their bodies, as long as it is not particularly serious, they usually seldom take the initiative to go to the hospital for examination.
Because they are afraid of spending money and delaying work.
The fourth disease Zhou Can thought of was medullary thyroid cancer, because the patient had hypokalemia and diarrhea, both of which were highly similar to the symptoms of medullary thyroid cancer.
In addition to the above four diseases that can cause patients to experience hypokalemia and severe diarrhea, colon villous adenoma can also cause severe diarrhea.
In just a moment, Zhou Can had already listed six or seven diseases in his mind that were highly similar to the patient's symptoms or were related.
What kind of disease it is needs further examination.
Just doing blood routine, urine routine, stool routine, small intestinal perfusion test and other examinations, the diagnostic basis provided is still too little.
"Director Zheng, can you please request an abdominal B-ultrasound examination for the patient?"
Zhou Can could no longer diagnose after reaching this stage.
"There is absolutely no problem in requesting an abdominal B-ultrasound examination. What is your current diagnostic idea?"
Zheng Hongtao understood that Zhou Can had a purpose every time he submitted a new inspection application.
But this time, he was a little confused and didn't know which item Zhou Can wanted to check on the patient?
"I want to check whether the patient has a tumor in the abdominal cavity. I just analyzed the diseases that may cause secretory diarrhea in patients, and several of them are related to malignant tumors. The current examination data is still too little to make further diagnosis. An abdominal B-ultrasound may be able to make new progress."
Zhou Can said truthfully.
"This weird persistent diarrhea may be related to cancer. It would be good to check the abdominal cavity. I hope it is not cancer. The boy is still so young and seems to be from a single-parent family. His mother raised him and trained him to be a college student. He finally entered the society and got a formal job, but he got such a disease. It's true that the hemp rope will break at the thinnest point and misfortune will only find the unfortunate!"
Director Zheng Hongtao sighed deeply.
He has been practicing medicine for so many years and has witnessed too many tragedies and disasters in the world.
Having seen so much, I am not numb at all. Instead, I have become more open-minded, like the Bodhisattvas in the temple.
No matter who goes to the temple to burn incense and pray to Buddha, the Bodhisattva never speaks.
Maybe there are no gods or Buddhas in the world, but people still believe in them happily.
If for no other reason, it is because as human beings we will always face different hardships and troubles in our lives, and we need a faith to strengthen our convictions.
After doctors have experienced too many situations where they are powerless, their mentality will change unconsciously. They will be full of compassion for the world and quietly try their best to help patients.
When you really can't help, you can only choose to look down on it.
"It's time to get off work today, so the medical technology department must be off work. We can only arrange for the patient to have an abdominal B-ultrasound examination tomorrow morning."
Director Zheng took the results of the patient's small intestinal perfusion test and arranged the next examination.
Zhou Can went to the ward to check on the twelve patients in his care. Generally speaking, they were all doing well. Three patients could be discharged tomorrow, and two more were scheduled for interventional treatment tomorrow. Four were going to have endoscopic surgery. The remaining three were in the nursing stage.
It is not difficult to find from these twelve patients that even in the Department of Gastroenterology, most patients are not treated purely with drugs.
Instead, it requires interventional, endoscopic, or minimally invasive surgery for treatment.
The reason why there are relatively few patients who are treated purely with medication in the inpatient department is that many of these patients take the medication home.
Try to avoid hospitalization if possible.
After taking the medicine for a period of time, you can come back to the hospital for a follow-up check.
After checking the ward and completing the handover, Zhou Can didn't have time to eat dinner and hurried back to his apartment.
From a distance, I could see Su Qianqian's BMW parked in a parking space on the side of the road.
"Doctor Zhou!"
Wei Fang had received professional security training, so her observation ability was much better than that of ordinary people. She spotted Zhou Can from a distance and quickly walked towards him.
"Come on, follow me upstairs!"
There was no expression on Zhou Can's face.
"Didn't I tell you not to call me Doctor Zhou anymore? From now on you can call me Brother Zhou, Brother Can, or Big Brother."
Zhou Can was quite satisfied with Wei Fang's work.
She was just a little too stubborn. She could choose a more intimate name when addressing Zhou Can, but she always insisted on calling him Doctor Zhou. And when she was with Zhou Can, she was always so respectful and reserved.
I went upstairs and entered the apartment where Zhou Can lived, but Jin Mingxi had not returned yet.
Compared with Zhou Can's relatively fixed working hours, Jin Mingxi enjoys the treatment of an ordinary trainee, and various overtime work makes him increasingly busy.
I need to discuss some confidential matters with Wei Fang today, so it's better if Jin Mingxi isn't here.
Otherwise we can only talk in the car.
After Wei Fang entered the room, Zhou Can closed the door.
She was alone in a room with Zhou Can, but she didn't feel nervous at all. She didn't seem to worry at all that Zhou Can would do something excessive to her.
In fact, Zhou Can’s character is indeed guaranteed.
"sit!"
He gestured to Wei Fang.
“Please drink some water!”
He poured Wei Fang a glass of boiled water, which made Wei Fang very flattered and she hurriedly stood up to take it.
"I asked you to come here today because I have something very important for you to do. This packet of powdered medicine is colorless and tasteless. When Qianqian meets Hu Wei tomorrow, you must find a way to put it in Hu Wei's drink. This person dared to betray Jinyu Interactive and caused so many troubles. He must be cunning. You must be careful when you give him the medicine. Try not to leave any handle."
Zhou Can dealt with the enemies and made full use of his advantages as a medical student.
"Don't worry, this is not poison. As long as you don't leave any evidence and act carefully, there won't be any legal risk. The private room where they talk will be deliberately chosen without surveillance, but you still have to be careful. If it's impossible, then give up."
Zhou Can made the decision to let Wei Fang do this after much consideration.
Currently, she is the only person around Qianqian who is useful and trustworthy.
"You saved my life, and you have given me a life I never thought possible in the past two years. I can do anything for you. If you or Miss Su are in danger, I can use my body to block bullets for you at the critical moment. I don't ask for anything else. If something happens to me, I only ask you to be filial to my grandmother and take care of her until she dies."
Wei Fang said something she had never said before in an extremely sincere tone.
Even if she didn't say it, Zhou Can believed that she would really use her body to help Su Qianqian block bullets in dangerous moments.
She just has this kind of loyalty.
"You don't have to worry about your grandmother's later years. If something happens to you one day, I will treat her as my own grandmother. But as an employer, I must tell you seriously that in addition to asking you to protect Qianqian, you should also protect yourself. Your life is as important and precious as Qianqian's, understand?"
Zhou Can said to her very seriously.
"Um!"
Although there was no expression on her face, the fluctuation in her eyes revealed that she was deeply moved by Zhou Can's words.
"There are two doses of the powder, so that you can remedy any special situation in time. You don't have to be nervous after Hu Wei drinks the drink, he won't have any symptoms in the short term..."
Zhou Can always does things in a mature, steady and mature manner.
Some possible accidents have been taken into consideration.
As long as Hu Wei took this medicine, he would have the opportunity to control this "beast" instead.
By then, Hu Haikun will definitely be played to the point of doubting his life.
