(Thanks to my friend Jiaqi under the sun, Silly Heart, and Divine Medicine King Poison Immortal Monthly Pass for encouragement)

"The cingulate cortex is a little fuzzy?"

Looking at the latest CT results, Liu Banxia couldn't help but mutter.

"Teacher Liu, does this mean that the patient often likes to joke and is in a good mood, and it is not his own reason?" Xu Yinuo asked.

Liu Banxia nodded, "The cingulate gyrus cortical area affects emotions, and now the patient's happy performance is also a symptom. However, this does not explain the patient's blurred vision and lack of blood vessel blockage. ”

"Who is Kaminai on duty here today, even though it's already the middle of the night, so let's go over and shout. We are not good at this, and we can't make mistakes now, so as not to delay the condition. ”

Xu Yinuo hurriedly called Zhang Ping, the doctor on duty in the gods.

She was most worried about the patient she was treating and she was operating on. How could you have thought of ordinary appendicitis surgery, and then there was intestinal perforation and blurred vision.

Even if the blurred vision can be explained by a brain lesion, but what is the intestinal perforation? She vaguely felt that it was related to appendicitis.

"Dr. Zhang, this is a CT scan of the patient. He was admitted to the hospital with acute abdominal pain and was diagnosed with appendicitis, which was complicated by intestinal perforation after resection. I just had a repair operation, and I have blurred vision again. Liu Banxia said.

"This is the latest CT scan, and the blood test results show a surge in the number of white blood cells. But after all, I had two surgeries, so it should be within the normal range. ”

"I'll take a look first, it seems to be quite complicated. Zhang Ping rubbed his eyes.

"Looking blurry now, it seems that there is an inflammation caused by a virus or an abscess, which has affected his emotional area. You can only check the spinal fluid and see how it goes. ”

"I can't see the cause of blurred vision from this film, right? Wang Lei is still worried, and just sent me a message to see if it is a postoperative reaction caused by anesthesia. Liu Banxia said with a wry smile.

"Probably not, it's almost caused by these inflammations. Zhang Ping said.

"Wang Chao, you can help check it, and I'll think about it again. Liu Banxia said.

Wang Chao nodded, this matter also needs to be discussed with patients and families. However, I generally do not refuse, after all, the CT film of the brain has already been examined for problems.

"Mr. Liu, I always think that the patient's appendicitis is related to intestinal perforation. Xu Yinuo said with a bitter face.

Liu Banxia nodded, "I also feel a little related, otherwise it would not have been so coincidental." And just now I thought about it again, and the patient's white blood cell index is indeed a little high. ”

"But now I have undergone two surgeries, and there is still some inflammation in the brain, which is also in line with the current disease indicators. But what's going on, even encephalitis should have nothing to do with intestinal perforation, right?"

Xu Yinuo opened her mouth, the situation was beyond her comprehension.

"Don't worry about it yet, I recalled your reception process, there was no problem, it was completely up to standard. The indications are clear at the time of the patient's presentation, and even if the appendix inflammation and intestinal perforation are external manifestations of the same condition, your operation is in accordance with the norms. Liu Banxia said comfortingly.

"Hmm...... If this is really the outward manifestation of the same disease, could it be due to the influence of parasites? Well...... Damn, it can't be amoebic disease, right?"

"After the patient has finished the puncture, I will do another stool test. The more I look at it, the more it looks, appendicitis, intestinal perforation, elevated white blood cells, brain inflammation, almost. ”

"It's really possible. Zhang Ping also nodded.

"Entamoeba histolytica trophozoites escape from the cyst and are prone to parasitism in the colon and cecum, and if some protozoa move into the appendix, it can cause inflammation of the appendix. ”

"And the parasite can also cause corrosive, ulcerative effects on the intestinal wall, which explains the intestinal perforation that follows in patients. Combined with the patient's current situation, it is not clear that the brain has been metastasized. ”

"Teacher Liu, is it okay to take metronidazole?" asked Xu Yinuo.

Liu Banxia shook his head, "Let's see if there is a cyst in the brain, if there is, not only is it not easy to clean up, but the prognosis is very poor." Let's get tested first, and then have an MRI scan after the diagnosis is confirmed?"

Zhang Ping nodded, "It's only like this, it depends on his luck." Hopefully, it is only because of the inflammation of the brain caused by the infection of the parasite, not because the parasite has metastasized. ”

"But I still wonder why I didn't think of this in the first place because it's the wrong month. Liu Banxia said with a wry smile.

"It's cold now, and it's snowing twice. Most of the amoeba protozoa live in warm and humid areas with tropical and subtropical climates, and we don't meet them at all. ”

"Even with the incubation period, it won't be as long as a month or two. Ten days is about the same, isn't it? How can it still be lurking for so long? ”

"Mr. Liu, you forgot to think about it. Amoeba protozoa don't move, but people do. You can run all over the place on a plane, and you can't tell where you are. Zhang Ping said with a smile.

Liu Banxia slapped his head, isn't it, it's too limited to think about the problem by himself. With such traffic nowadays, patients can really walk around.

In fact, the normal examination sequence should be supplemented with a colonoscopy to be able to see more clearly. However, the patient has just undergone intestinal perforation surgery, and it is likely that the perforation site will be damaged during colonoscopy.

However, it is possible to confirm the diagnosis with these current methods, and if trophozoites that phagocytose red blood cells are found in the stool test and high concentrations of amoebic antibodies are found in the serum, the diagnosis can be confirmed.

"Teacher Liu, you can be diagnosed. There were only some infections in the brain, and no trophozoites were found in the spinal fluid. After surviving, Xu Yinuo ran over happily with the report sheet.

Ding! Patient reception is done

Gain 100 XP and 100 Diagnostics Skill Mastery

Liu Banxia smiled and nodded, "I'll leave it to you to inform the family, and when the patient wakes up, ask accordingly to see if his family has the same travel history as him, and has used the same foreign food." ”

"Besides, this case is to sort it out and give you an explanation as a typical case. It can also serve as a warning to everyone, so that everyone will not have a clue about such a disease in the future. ”

"Well, Mr. Liu, you can go to sleep first. Xu Yinuo happily responded.

She has always been very worried about this patient's condition, and she is afraid that the patient's intestinal perforation was caused by her laparoscopic appendectomy.

Intestinal perforation is a disease that can be big or small, and if it is small, it can be repaired. At worst, it can be life-threatening.

And regardless of whether the patient had a bowel perforation after admission to the hospital because of her operation, even if she couldn't find a procedural error, she felt that she was not careful.

If the patient's first attending physician had been Liu Banxia, he might have done some further tests on the patient's appearance, rather than just staring at the appendicitis.

After tossing around, Liu Banxia was not so sleepy. Directly let Wang Chao and them rest, and he will stare at it the rest of the time.

In fact, the indications of this patient today are really very obvious, but even he didn't think deeply, fortunately, he didn't delay the patient.

Otherwise, when the patient's wound recovers, he will vigorously check why the white blood cells are so high. At that time, it will take a long time to diagnose the patient's disease.

"Why don't you take a break for a while?" After sorting out the rest of the cases, seeing that Xu Yinuo was still here, Liu Banxia asked with a smile.

"Mr. Liu, I can't sleep, I just talked to the patient's wife and found out that the patient was indeed on a business trip, a week ago. Xu Yinuo said.

"I guess I was infected while playing locally, otherwise there would be no other source of exposure. And three of his colleagues have also called to inform them that they will come to us tomorrow for an examination. ”

"Then you have to take a break, and tomorrow you can see these patients and give them a detailed examination. Liu Banxia said.

"It was a good performance today, but I need to have more confidence in the future. Your current business skills are also very good, and you can cope with some routine surgeries. ”

"Thank you, Dr. Liu. Xu Yinuo nodded happily.

For her, Liu Banxia's praise is already rare. Especially now that she is just an intern who has not graduated, she has already had a lot of practical opportunities here.

Liu Banxia didn't care about him anymore, he participated in the diagnosis and treatment of such a case, if he had been so excited before. It's just that there are many patients who have experienced it, and it seems that only emergency surgery can make him feel this way.

There was still some time before breakfast, and he began to think about it.

Is it also possible to launch a weekly irregular meeting in the emergency center, where the big guys analyze cases and discuss medical malpractice together, which will definitely deepen the impression of the big guys.

In fact, the Second Hospital now has such a regular meeting, but it is more of a praise for excellent diagnosed cases, and less discussion on medical malpractice.

Although some cases may not be determined as medical malpractice, if you pay more attention and open your mind in the process of receiving treatment, you may be able to produce another result.

Anyway, the emergency center now operates independently, and later you can find a conference room upstairs and bring the doctors together to play by yourself.

The emergency center is not only a department that the hospital attaches importance to, but also a place where he is really struggling now. He has been working here since the establishment of the emergency center, and even if there are some minor accidents, his feelings for this place will not change.

And for him now, there is basically no possibility of changing jobs, and he will be in the second hospital for the rest of his life, and he will also build an emergency center.