"The patient, female, 22 years old, conscious... stunted and malnourished, went to the obstetrics and gynecology department of our hospital on February 14 with nausea, vomiting, abdominal pain, and abdominal distension. The obstetrics and gynecology department has completed relevant examinations and various physical examinations No obvious abnormalities were found, so the Department of Gastroenterology of our hospital was invited for consultation.
After consultation with the chief physician of the Department of Gastroenterology of our hospital, the patient's symptoms improved after being given antispasmodic drugs to promote gastrointestinal motility. However, on February 16, the patient's symptoms worsened, and after being given antispasmodic drugs to promote gastrointestinal motility again, the patient's symptoms improved. No significant improvement was seen.
Therefore, after the patient was transferred to the gastroenterology department, colonoscopy and gastroscopy were performed. The colonoscopy showed that there was obvious purulent mucus in the patient's intestines, and intestinal infection was considered. After being given anti-infective drugs on the same day, the patient showed no significant improvement.
Therefore, after the third-level diagnosis and treatment, the Department of Gastroenterology decided to apply for hospital-wide consultation. After reporting to the dean, the dean agreed, and the approver was dean Zhang Fan! "
After Lao Chen picked up the microphone, he began to explain the patient's main complaint about admission and the diagnosis and treatment process. The experts present already had a copy of the medical record and examination in their hands.
But with the examinations and medical records in their hands, each expert has already begun to think about the diagnosis in his own mind according to his own discipline.
Ouyang looked at the report in his hand and put it down. In the past few years, the old lady had either been thinking about the hospital's personnel structure or fighting with the contractors on the construction site. Professional, especially cross-professional cases, could no longer keep up.
"Have you ever seen this kind of case? Did you communicate with everyone before the meeting?"
"No!" Zhang Fan looked at the case and said softly.
Ouyang took a breath of cold air and gritted his teeth. "You are too careless. If you don't get off stage today, you will probably be embarrassed in the capital!"
Ouyang is so worried. After reading the case, Zhang Fan smiled at Ouyang, "It's okay!"
Then, I looked at the experts in the venue and had already put down the cases in their hands. "Everyone has seen the case, okay, now everyone will talk about it. Since it is admitted from the Department of Obstetrics and Gynecology first, the Department of Obstetrics and Gynecology will talk about it first."
Zhang Fan nodded to several experts in obstetrics and gynecology.
The director of the obstetrics and gynecology department gently said something to Lu Shuyan, and Lu Shuyan stood up.
"After the patient was admitted to the hospital, our department first determined that the patient was not pregnant." Many people were particularly curious during the examination at the hospital. Girls of childbearing age entered the hospital, whether it was a greasy general surgeon or a stout orthopedic surgeon. , anyway, after asking you what's wrong, I'll ask you whether you're married or not, and whether your menstruation is normal.
It seems like parents are urging marriage during the Chinese New Year. In fact, this is a medical regulation. Women of appropriate age must ask whether they are pregnant, because many tests and drugs must not be used during pregnancy.
"Although the patient's menstruation is intermittent, various data show that the patient's irregular menstruation is not the direct cause of abdominal pain, bloating and nausea, but the patient's abdominal pain and bloating has actually affected the patient's gynecological system..."
Lu Shuyan has finally mastered it, and she can explain the physical signs of each patient in quite detail. The director of gynecology nodded with satisfaction.
If Zhang Fan is Ouyang's sweetheart, then Lu Shuyan is now the crown prince of gynecology. Lu Shuyan is currently the assistant director. Although she does not have the title of deputy director, she is currently responsible for the department's current scheduling, professional studies, and emergency surgery.
"This senior sister is so handsome and aloof!" A few singles among the interns secretly thought to themselves.
After the introduction of gynecology, the introduction of gastroenterology is given.
…
After each department finished speaking, the experts began: "Although I have not seen the patient, I think we can continue to observe. The ward rounds three times a day can be divided into rounds every two hours. There will always be ward rounds before and after she gets sick. Clues were found after the onset of the disease."
Experts from Maruko Country expressed their opinions. In the land of meatballs, the number of doctors managing beds is small. Therefore, they focus more on clinical observation.
"Infectious white pus was found in the intestines. Although the specific cause of infection cannot be determined at present, we can perform laparotomy to confirm the diagnosis."
Zhao Jingjin enlarged his move.
"No, the patient's current nutritional status obviously does not support surgery. Moreover, at present, the patient's focus is not on the small amount of infected fluid secreted in the intestines, but on what caused her obvious nausea and vomiting."
Yan Xiaoyu objected to laparotomy.
This is the biggest difference between internal medicine and surgery. Surgery is simple and crude. If it doesn't work, just open your stomach and look at it. Internal medicine, on the other hand, pays attention to mechanisms and principles.
Internal medicine cannot convince surgery, and surgery cannot convince internal medicine.
"Well, based on everyone's current suggestions, my opinion is that we conduct another systematic physical examination."
"Okay, I agree!"
"I agree!"
…
"Hey, there is still no expert who can give the final say. If this disease were in our affiliated hospital, the boss of the gastroenterology department would probably be able to spot it at a glance."
"I don't think so. I looked at this patient yesterday and had no clue at all. She just had occasional irregular nausea and vomiting. My first reaction was that she was pregnant. After ruling out pregnancy, I couldn't think of any other diseases she had. All tests are normal!"
Several students gathered together to discuss.
Integrated treatments are becoming more and more popular around the world. However, the cost is too high. Some hospitals in China have also set up outpatient clinics and wards in the form of comprehensive departments, but the results are really nonsense.
If comprehensive diagnosis and treatment are occasionally combined, the effect is quite powerful. But once it becomes a regular department, it will be troublesome. Either it's a group of doctors who are all average in their subject hanging out together, or it's a group of great masters who quarrel every day.
At present, comprehensive diagnosis and treatment is relatively good, that is, it is slightly better in pediatrics. The development of comprehensive diagnosis and treatment in other disciplines is also the same.
"Okay, now the general direction has been determined, which is insufficient gastrointestinal motility, so let's go to various departments for consultation. Director Chen, please arrange a teaching classroom and explain it to the patient's family. We will let various experts do a physical examination on site."
"It's ready, and the family members have agreed." Lao Chen has been ready for a long time. With this kind of work attitude, people who can become Evergreens definitely have a way of doing it.
In the large teaching classroom, the patient lies on the treatment bed accompanied by the nurse.
Although the girl is in her early twenties, her height, weight, and growth look like that of a teenager.
The girl was scared at first, but now she saw dozens of people surrounding her, and there was also a group of young-looking guys, which made the girl scared and shy at the same time.
To be honest, the patients in China are really good. If this were done abroad, patients would demand that I have privacy and cannot allow so many doctors to come.
As for this little girl, although she was shy and a little scared, she was still very strong and took off her hospital gown, revealing her white abdomen and chest.
Zhang Fan looked at the girl's body and felt very emotional. This disease must have been tormenting the girl for a long time.
Because this girl is more delicate, she looks like she has the figure of a little doll, and her breasts are not as developed as those of some fatties.
The physical examination begins.
"Let me do it, everyone will add it!" Zhang Fan originally wanted all the experts to show their hands to these interns, but when he saw the patient trembling like a kitten, he suddenly said.
"Don't be afraid, we are all doctors. We will find the cause of your illness and make you healthy." Zhang Fan said softly.
The girl seemed to be particularly convinced. She bit her lip and nodded gently, and her tense muscles relaxed.
"Okay, curl up your legs, yes, that's it!"
The physical examination begins...
