Chapter 2134

Looking at the front film, the patient's diagnosis is very clear. It is primary liver cancer.

There is a 3 on the liver × 4cm lesions, and the gallbladder is intact, not to mention stones. The gallbladder wall is not even rough.

And what Zhao Wenhua inserted is not a front film, but two.

The first one is the preoperative film. There is no lipiodol in the lesion. The second film is after embolization. The date should be the operation done a few days ago.

In the recent film, the tumor has been necrotic and the image of the needle path can be seen. It should be radiofrequency ablation after embolization.

"It shouldn't be gallstones." Zheng Ren said definitely.

After watching the film, he knew where Zhao Wenhua was tangled.

Zhao Wenhua nodded again and again, "boss Zheng, there was no gallstone before the operation. It's only a few days, and it's impossible to have a large number of sediment like gallstones. This is a conventional logical judgment, but it happens to be in imaging."

Then he sighed helplessly.

Sometimes there will be errors in image and logical judgment, and most doctors will take objective image judgment as the final basis.

After all, the image exists objectively. Otherwise, what is the significance of doing image examination for patients. In many cases, thinking logic is limited by the quality and level of doctors themselves. Even, it has something to do with environment, emotion and other factors.

However, at Zhao Wenhua's level, objective images can only be used as one of the reference standards. He will not believe in any objective images.

The higher the level of doctors, the more problems they will consider.

Every problem that cannot be solved logically may have a very rare situation, leading to further deterioration of the patient's condition and even death.

Even if there is a typical imaging diagnosis on the film, you must understand it.

This is why Zhao Wenhua was stunned when he looked at the CT film with a "clear" diagnosis.

Because he can only feel that there is a problem, but he can't overturn the diagnosis of gallstone. The contradiction between the two makes people have no choice.

"What about other tests?" Zheng Rendao.

Lin Yuan sat aside, writing a medical record. She was a little sleepy, but when boss Zheng said this, she was refreshed.

This is the tone of the superior doctor. As the bottom doctor of boss Zheng's medical team, I must run to hand over other tests he needs.

At Harvard, it was the same. Back to 912, it was the same.

However, Lin Yuan was stunned the next second.

She saw Zhao Wenhua, one of the professors in the 912 intervention department, bow slightly, run to the computer and print out all the patient's examination reports.

The printer is buzzing and pages of A4 paper spit out.

Lin Yuan looked at Zhao Wenhua in surprise and saw that he looked anxious. Every time a report came out of the printer, he had to get it directly in his hand.

As for you!

Although boss Zheng doesn't want to laugh at ordinary times, and it hurts to knock on the styloid process of radius with hemostatic pliers on the operating table, he is still very kind at ordinary times.

Lin Yuan didn't understand why Professor Zhao Wenhua showed such a humble attitude. It's... more like a little doctor than yourself.

"Boss Zheng, look." Zhao Wenhua immediately took the problematic test sheet in his hand and blew air to reduce the temperature of the printer on A4 paper.

Sure enough, the patient had high leukocytes, high hematuria amylase and elevated serum lipase.

Lower blood calcium and higher blood sugar

Zhao Wenhua has rich experience and has done all the inspections that should be done. Zheng Ren has nothing to be picky about.

"Do patients have diabetes history?" Zheng Ren asked.

"No." Zhao Wenhua answered immediately.

Without history of diabetes, blood glucose is elevated and blood calcium is reduced, which is one of the clinical tests for typical acute pancreatitis.

Is it the postoperative stress response that leads to cholecystitis and acute pancreatitis? Zheng Ren looked through the test sheet and thought.

Although he thought so, he did not draw a simple and rough conclusion.

The patient's laboratory test sheet and imaging examination point out very clearly - acute gallstone and acute pancreatitis.

But!

There is still no way to explain how so many sediment like stones come from.

If the gallbladder wall is rough, it is estimated that Zheng Ren will give up thinking about it at this time. But there are a lot of sediment like stones in the gallbladder from scratch. What do you think is wrong.

Moreover, it is a postoperative patient. Even if the diet is irregular at ordinary times, the family takes care of them very carefully. If they can eat, they can settle down.

Weird.

Zhao Wenhua looked at Zheng Ren and looked forward to it.

"Tell me about the patient." Zheng Ren stood in the position of reading the film, holding his arms and supporting his cheeks, looked at the film seriously, and said faintly.

The little doctor of Zhao Wenhua's group was about to speak when he was interrupted by Zhao Wenhua.

"Well, boss Zheng." Like a subordinate doctor, Zhao Wenhua began to report his medical history.

"The patient came to our hospital for treatment one week and was initially diagnosed as liver cancer. When I went out of the clinic, I took the patient in. Three days ago, I underwent interventional embolization + radiofrequency ablation for liver cancer. There is a film, which is the image left after interventional embolization."

Zheng Ren nodded, indicating that he knew.

"The postoperative recovery of the patient was quite good. This morning, he suddenly complained of severe abdominal pain. Urgent CT examination found gallstones and pancreatitis. Please consult and the diagnosis of hepatobiliary surgery is the same. Symptomatic treatment is recommended."

"But I saw the film and thought it was a problem." Zhao Wenhua is very cautious, "the patient is not in good condition now, and the pain has not been relieved."

"Did you give analgesics?"

"I didn't give up. I haven't figured out something yet."

Zheng Ren nodded.

If you don't understand, give analgesics. That's death.

incorrect! I just looked at the test sheet. It seemed that there was something wrong. I flashed by and didn't pay much attention.

Zheng Ren picked up the test sheet again and looked at it one by one.

Soon he found the problem. The patient's blood routine leukocyte is high, which can be used as one of the auxiliary diagnostic evidence of cholecystitis and acute pancreatitis.

However, the patient's hemoglobin has dropped to 76g / L, while the preoperative hemoglobin is normal.

"Anemia? Professor Zhao, what do you think?" Zheng Ren asked.

Zhao Wenhua shook his head in a daze.

Neither radiofrequency ablation nor interventional embolization can cause anemia.

Let's not talk about interventional embolization. A needle eye is placed on the femoral artery of the thigh, and then the guide wire and catheter enter to conduct embolization treatment inside the blood vessel. Bleeding complications are rare because embolization itself is one of the hemostatic treatments.

In the case of RF ablation, the RF needle is not thick. It is inserted into the liver. When it is pulled out after ablation, the RF needle should be heated to avoid needle path transfer.

While killing tumor cells, the puncture needle path will also be "scalded" again. Even if there is capillary bleeding, it is like electric burning, and the bleeding is stopped.

There was no anemia before the operation, and there was no first reexamination after the operation. It was only early this morning that progressive anemia occurred.

This is a particularly suspicious point.

……

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