Back in 2002 as a doctor

Page 919

"I don't even need to ask the patient's condition, I can say that more than 95% of the patients are fine."

"!!!" Shen Lang was stunned.

Bloody urine, all right?What a joke!

"By the way, are you going to Tianya Forum?" Zhou Congwen asked.

"Occasionally, it's interesting."

"One person made up a joke, saying he had blood in his urine, which frightened him to death, took a lot of medicine, and left a suicide note. Later, he found out that he ate dragon fruit."

"Hahaha." Shen Lang was amused, "Just kidding, the pigment of dragon fruit doesn't get into the urine. I have seen this kind of patients a lot in the emergency department. They all have red stools, and I thought it was digestion The bleeding is actually eating dragon fruit."

"With so many patients, I haven't seen a single one with symptoms of hematuria."

Zhou Congwen smiled, "Right, he just made up a joke."

Shen Lang raised his eyebrows, "Congwen, you're talking about making up jokes... If I make up jokes, it's okay."

"Just rely on the score." Zhou Congwen said casually.

"I see!" Shen Lang was silent for a few seconds, then suddenly clapped his hands, looked at Zhou Congwen and said loudly, "You are evading and changing the subject."

Zhou Congwen was stunned, trying to escape.

The dragon fruit you just mentioned?Tianya community?or something else?Shen Lang's mind jumped so fast that Zhou Congwen couldn't keep up.

"You said that 95% of the child is fine, but you know that you have no way to treat it, so you just keep out of sight and out of mind." Shen Lang said firmly.

Zhou Congwen couldn't laugh or cry.

He stopped, turned to look at Shen Lang, and soon a smile appeared on his face.

"Shen Lang, how about we make a bet."

"What are you gambling?"

"a meal."

Although Shen Lang wasn't short of a meal, he could feel something was wrong.Zhou Congwen lured him like a villain, and there was a trap ahead.

But Shen Lang thought about it for a long time, and he didn't know where the problem was.

He hesitated and hesitated, and finally said, "Okay, bet!"

"Shen Lang, we have seen many thin and tall boys in the past, usually high school students, what disease would they most like to have?" Zhou Congwen asked.

"Spontaneous pneumothorax."

"Well, in addition to this, there is another disease, which is blood in the urine."

Chapter 1580 You can tell at a glance, is it so amazing?

Seeing Zhou Congwen's serious nonsense, Shen Lang was also speechless, feeling contemptuous in his heart.

This is Shen Lang. When he met Zhou Congwen in his infancy, he saw Zhou Congwen's downcast appearance, so Shen Lang seldom treated Zhou Congwen as an old expert.

What Zhou Congwen just said sounded very unreliable to Shen Lang.

Thin and tall boys are willing to get spontaneous pneumothorax because of the slight deformity of the thorax during growth and some pathophysiological reactions.

The probability is actually not high. The Thoracic Surgery Department of the Third Hospital of Jianghai can accept 1-2 similar patients a year.

But Shen Lang had never heard of blood in the urine, and it had nothing to do with spontaneous pneumothorax at all.

"Patients generally have hematuria and proteinuria. If the urologist or nephrologist is not qualified enough, they will judge it to be nephritis." Zhou Congwen said.

"And then?" Shen Lang asked.

"What's more, it is more likely to occur in young boys, and there is usually concurrent left varicocele."

Seeing that Zhou Congwen was very sure of what he said, Shen Lang didn't care about eating or not, so he turned around and walked back.

"Congwen, wait for me!" Shen Lang finally said.

Zhou Congwen smiled when he saw Shen Lang disappearing from sight like a wild dog that had run loose.

This kind of disease is rare in grass-roots hospitals, but it is very common in the top three hospitals in the imperial capital and Shanghai.

It's not that the children in the imperial capital and Shanghai are willing to get this disease, but that the nephrologists in the basic hospitals don't know what's going on, and the treatment hasn't improved for a while, so they can only advise the family members of the patients to take the patients to higher-level hospitals.

Patients from all over the country gather in the imperial capital and the magic capital. In fact, this can be regarded as a kind of hierarchical diagnosis and treatment.

After watching too much, Zhou Congwen has long been familiar with the strangeness, but Shen Lang still doesn't know the specific reason.

In this day and age, quite a few doctors in the Third Hospital of Jianghai City don't even know about aortic dissection, let alone Nutcracker Syndrome.

Twenty years later, there are not many nephrologists in primary hospitals who can accurately diagnose Nutcracker Syndrome.

Many children are treated as nephritis. Although it will not lead to serious consequences, it is still misdiagnosed and mistreated.

Shen Lang ran into the emergency department quickly. He took a chance and asked when there were not many people in the emergency room, "Sister Pang, how about the child who urinated blood just now?"

"Shen Lang, you're still here." The female doctor in the emergency department looked up at Shen Lang, and then started typing on the keyboard again.

While there were no patients, I wrote the observation records. Who would have the time to talk to such a gossip like Shen Lang.

"Sister Pang, it's the child who urinates blood. How is he? Is the problem serious?" Shen Lang leaned over and asked with a thick skin.

"That kid, I asked him to go home and observe."

"Ah?!" Shen Lang was stunned, "Sister, the child is urinating blood, why don't you go home and observe, it's not nephritis or kidney tumor."

"What are you talking about." The emergency doctor glanced at Shen Lang, "I've checked, there are hematuria, proteinuria, and varicocele, I did a CT scan, and I saw the left renal vein..."

"Wait!" Shen Lang immediately interrupted the emergency doctor when he heard the diagnosis that Zhou Congwen said just now.

"What's wrong?" The emergency doctor frowned, raised his head, adjusted his glasses, and looked at Shen Lang like an idiot.

Although Shen Lang usually gossips, he is very diligent. When he eats, Shen Lang changes into a white suit to help him stand up for a while.

So she still tried her best to give Shen Lang a good face, even though Shen Lang had delayed her work now.

"Shen Lang, have you never seen a patient with Nutcracker Syndrome?"

"Ah? What clip?" Shen Lang had never heard of it before, and asked the emergency doctor in a daze.

"It often occurs in young boys, mainly aged 12-18, usually in junior high school, with hematuria and proteinuria."

"..." Shen Lang was stunned.

What the emergency doctor said was exactly the same as what Zhou Congwen said, Shen Lang didn't understand at all.

"So after the patient came, I looked at the age, then looked at the test sheet, and asked him to take off his pants and take a look at the spermatic vein to roughly know what's going on." The emergency doctor said, "The left varicocele is so typical. .”

"..."

"Then get a CT scan and come back to see what's going on."

"What's going on?" Shen Lang asked, in a hurry.

"When the left renal vein flows back into the inferior vena cava, it is squeezed in the angle formed by passing through the abdominal aorta and the superior mesenteric artery or in the space between the abdominal aorta and the spine, often accompanied by a decrease in the blood flow velocity of the left renal vein. Descending, dilation of veins distal to the site of compression."

"In human terms, the child is too thin, there is a problem with the space in the abdominal cavity, and the blood vessels are squeezed. According to the physiological and anatomical structure, the problem is usually the left kidney."

"!!!" Shen Lang was extremely astonished.

"Although I haven't seen the result, I'm basically sure."

"How to treat?" Shen Lang asked.

"The vast majority of people don't need treatment, and the varicocele will heal after they grow up." The emergency doctor said with a smile, "A small number of people need surgery, but it is generally not recommended."

As she spoke, she lowered her head and began to retype the medical records.

"It wasn't an emergency department at first, but they have come all the time, and the symptoms are still so typical, so we don't let patients go to the outpatient clinic." The emergency doctor said, "It's not troublesome to do an enhanced CT to see the blood vessels.

When the diagnosis is clear, I will explain to the family members of the patient that he is not in a hurry. "

"I'll go, sister Pang, is it so amazing?!" Shen Lang asked in astonishment.

"Is it miraculous?" The emergency doctor didn't think so. "It's just that the level of doctors in basic hospitals is a bit problematic, but it's understandable. If the level is as high as our 912...it's impossible."

The emergency doctor and Shen Lang are already familiar with each other, knowing that he came up step by step from the grass-roots hospital, and his basic knowledge and clinical experience may be poor, so he only spoke half of what he said.

Shen Lang also ignored the disdain and offense in the emergency doctor's words, he didn't care about these things at all, he wrote down everything that should be written down, and ran to the CT room in a hurry to wait for the child to be examined.

The results of the examination were exactly the same as what the emergency doctor said—the inferior vena cava was located on the left side of the abdominal aorta and accompanied upward; at the level of the renal artery, the right renal vein passed between the abdominal aorta and the spine into the inferior vena cava, and the right renal vein Impression marks can be seen at the intersection with the abdominal aorta; the inferior vena cava ascends to the intersection of the abdominal aorta and No.12 rib, wraps around to its right side and continues to ascend.

Is it really so amazing? !

Shen Lang stared at the blood vessels on the screen for a long time in doubt.

The doctor in the CT room also knew Shen Lang, he said with a smile, "Little Shen Lang, haven't you seen him?"

"Yeah." Shen Lang was a little at a loss, how could even the doctors in the CT room know.

Chapter 1581 The Nutcracker

"Uh... I really haven't seen it before." Shen Lang said frankly.

It is Shen Lang's advantage to be quick to admit love.Coming to 912 from a primary hospital, except for Zhou Congwen, everyone else is a teacher, Shen Lang has such an awareness in his heart.

"Normal." The doctor in the CT room said with a smile, "We have seen a lot of children like this in 912. This is called Nutcracker Syndrome. Here, Xiao Shen Lang, do you think this blood vessel looks like a nutcracker?"

"What is a Nutcracker?" Shen Lang asked.

"..." The doctor in the CT room was speechless, he was confused by Shen Lang's question.But after thinking about it, it might be due to regional differences. He explained, "A tool for clamping walnuts, V-shaped, put the walnuts in, and then use the principle of leverage to crush the outer shell of the walnuts."

Shen Lang roughly understood what it meant.

It's just that the Northeast, or Shen Lang seldom eats walnuts, so he doesn't know much about this stuff.But the principle is simple, and after explaining it, Shen Lang has a preliminary understanding.

"Here, here." The doctor in the CT room pointed at the image on the screen and said, "It's like a nutcracker, so this disease is called Nutcracker Syndrome."

"Tsk tsk." Shen Lang sighed a little, it was really vivid.

Before Zhou Congwen told himself that 912 was more lively, Shen Lang was still dubious.Although he didn't think what Zhou Congwen said was right, Shen Lang wasn't stupid, it must be good to be able to come to 912.

Unexpectedly, after a period of time, it is really a long experience.

For example, the Nutcracker Syndrome is not only diagnosed by experts in 912.Emergency doctors and doctors in the CT room all know that they have experienced many battles, and they have seen it countless times.

"Amazing!" Shen Lang exclaimed.

"You'll know it once you've seen it." The doctor in the CT room said with a smile, "I won't ramble..."

Just as he was talking, a head poked through the door.

"Doctor, how about Qin Qin's film?"

The patient's family members were a little timid, but also asked expectantly.

"It's okay." The doctor in the CT room said, "It's a small ailment that the child is willing to get when he grows up. It doesn't matter. Basically, no surgery is needed. It will be fine when he grows up."

This news was the kind that the patient's family could not wait for, but when he really heard it from the doctor in the CT room, he was a little skeptical and puzzled under the ecstasy.

"Here, take the film and go to the outpatient clinic, and the doctor will explain it to you."

The doctor in the CT room really didn't want to waste his words. He had seen too many similar patients, and he didn't have the time to explain the condition.

There are countless patients queuing up outside, so it's definitely not good to leave the work to the night shift if you can't finish the work.

And more importantly, the family members of the patients who lined up must have a bad temper. Now that their emotions are on the verge of collapse, it must be a disaster if they talk too much.

Many disputes come from this.

If you end up being beaten up for explaining the condition to other patients, why bother?

The doctor in the CT room didn't want to cause trouble for himself, so he handed over the film to the patient's family, told him to return it later, and drove him away if he had to issue a report.

Shen Lang recalled what the emergency doctor and the doctor in the CT room said just now, feeling very emotional.

He found Zhou Congwen and explained the matter.

"What did I say?" Zhou Congwen said with a smile, "Let's reply now."

"Congwen, how did you know that?" Shen Lang asked.

"This is a wealth of clinical experience." Zhou Congwen said, "For example, the patient you mentioned, I can guess how the local doctors deal with it."

Zhou Congwen said so, but he felt a little ashamed.

Before there was no system in his last life, he also encountered a similar small patient in the Third Hospital of Jianghai City, who made a mistake in diagnosis and treatment.The family members of the patient took the patient to see a doctor in the imperial capital, and scolded Zhou Congwen when they came back after the diagnosis was confirmed.