Niu Dabao glanced at Xiong Changlong helplessly, and said in his heart You don't want to explain too much to a freshman raw melon egg, so I'm willing? Not to mention that this raw melon egg itself is still a student of your Tianyang College of Traditional Chinese Medicine!

However, complaining is complaining, Niu Dabao is really not good at refusing Xiong Changlong's orders at this time, after all, Xiong Changlong is a consultation expert hired by them, and Zhao Dongdong's follow-up treatment still needs to rely on Xiong Changlong's medical skills.

Niu Dabao didn't look at Ren Jiangchi, but looked at Zhou Rujun and his wife to show that he was explaining to the two of them, not Ren Jiangchi, a raw melon egg.

"Director Zhou, Mr. Zhao!" Niu Dabao said: "Liver abscess is mostly manifested by irregular septic fever, especially bacterial liver abscess. Pain in the liver area is constant and increases with deep breathing and positional movement. Due to the different parts of the liver where the abscess is located, it can also produce corresponding respiratory symptoms and abdominal symptoms, and the liver is mostly enlarged, and most of them will have localized edema and obvious tenderness in the intercostal space equivalent to the abscess.

Judging from Dongdong's physical examination, his body temperature was normal, and he had no cough, vomiting and diarrhea. There was no tenderness in the abdomen or intercostal space, and no symptoms of limited movement!

"More importantly, the abdominal ultrasound examination did not reveal an abscess cavity in the liver, but only indicated an intestinal effusion and abdominal lymphadenopathy. Generally speaking, as long as a liver abscess is formed, it can be seen on B-ultrasound images.

"So from these signs, it is completely impossible to see that Dongdong has a liver abscess. So I don't understand how your niece, a male classmate, came to the conclusion that a liver abscess is compressing the phrenic nerve!"

Speaking of this, Niu Dabao paused and turned his head to look at Qian Fangzhao, "Of course, my specialty is in orthopedics and traumatology, and I can also be regarded as an amateur in the field of internal medicine, such as liver abscess." Dean Qian, you are an expert in the field of internal medicine, and I must have said a lot of things that are not in place or incorrect, and you need to correct them more!"

Although Qian Fangzhao is best at cardiovascular medicine, he is at least in the top three in the field of gastroenterology of the Municipal People's Hospital. Hearing that Niu Dabao threw the topic to him, he naturally did not shirk, and said with a smile: "Director Niu, you are too modest, if you are a layman at this level, I'm afraid few doctors dare to say that they are experts in the field of internal medicine, right?"

Then he looked at Zhou Rujun and Zhao Mingkai again, "Director Zhou, Mr. Zhao, Director Niu has explained in great detail just now. However, I would like to add a few more points to his explanation.

"The first is that although liver abscess often has fever symptoms, it is not without fever. If the liver abscess has passed the acute infection period and enters a period of chronic stability, and the liver abscess is well wrapped, the patient may not have fever. Therefore, whether a patient has a fever or not is not a necessary condition to determine whether he has a liver abscess. ”

Niu Dabao didn't show any shame on his face when he heard this. The so-called hearing has a precedence, and there is a specialization in the art industry. Modern Western medicine is very meticulous in terms of specialization, and as an expert in orthopedics and traumatology, he naturally cannot understand liver abscess as thoroughly as an internal medicine expert like Qian Fangzhao. It is precisely because of this that when encountering difficult diseases, the hospital will conduct multi-doctor consultation, that is, doctors from various departments need to judge the patient's condition from their own professional perspective, and then synthesize to draw an accurate conclusion about the patient's condition.

Qian Fangzhao continued: "Second, although the vast majority of patients with liver abscess will be tender and tender, there are also a very small number of patients who will not be tender or tender due to the special location of liver abscess. Therefore, whether there is tenderness or tenderness is not a condition that completely excludes whether the patient has a liver abscess. ”

Xiong Changlong was a little unable to sit still when he heard this, his eyes only tilted to Qian Fangzhao, thinking to himself, where are you sitting on the side of your ass?

Qian Fangzhao ignored Xiong Changlong's eyes and continued: "However, Director Niu has a good sentence, that is, as long as the patient has a liver abscess, it will definitely be reflected in the B-ultrasound image, so the B-ultrasound image is the gold standard for checking whether the patient has a liver abscess!"

"From the early stage of liver abscess, the ultrasound showed that the liver lesion area had a vague boundary of the hypoechoic area, and the internal echo was uneven, which continued with the surrounding liver tissue. The abscess progresses further, and necrosis liquefaction may occur in the lesion area, forming an abscess cavity. The thickness of the entire abscess wall is uneven, generally the outer wall is relatively rounded, a few abscess walls are relatively thin, and the inner wall can also be flat.

"The echo behind the liver abscess is generally enhanced, the lateral wall is generally not echoogenic and the internal echo can be hypoechoic and evenly distributed, and the mixed echo is unevenly internal echo. Poor echo, patchy, coarsely punctate, and drainy-like clear. There is a severe reaction outside the outer wall of most liver abscesses, and chronic abscesses may show a semi-circular bright arc reflex above the cyst wall and, rarely, gas-producing bacilli in liver abscesses.

"And all of these are not prompted on Dongdong's abdominal B-ultrasound image, so when our hospital organized a general practitioner to consult Dongdong this morning, no one in the hospital put forward the opinion that Dongdong has a liver abscess. ”

"So, young man!" Qian Fangzhao finally turned his gaze to Ren Jiangchi, "Your idea of a liver abscess compressing the phrenic nerve and causing shoulder pain is very novel, and it is true that this phenomenon may occur in some patients. But unfortunately, when it comes to Zhao Dongdong, there is no evidence to support your conclusion!"

Qian Fangzhao said such a big thing, if Ren Jiangchi didn't have the mobile phone system in his mind to support him, maybe he would have retreated a long time ago. But now, Qian Fangzhao has listed 10,000 reasons, and Ren Jiangchi will definitely not change his position, there is no other reason, that is, when he used a flashlight to see through, he had clearly seen the liver abscess in Zhao Dongdong's body, and he also clearly saw that the part of the abscess had caused serious pressure on the phrenic nerve!

"Dean Qian, although you said that B-ultrasound imaging is the gold standard for diagnosing liver abscess, then I would like to ask you a question, has there been a case where B-ultrasound examination has not been detected but the patient actually has a liver abscess?"

Qian Fangzhao pondered for a moment, "This kind of rare case does exist, but there are extremely special reasons. I don't think that when it comes to Dongdong, there are these reasons. ”

"So what if there are really these special reasons that make the patient's liver abscess undetectable by ultrasound examination?

"Of course there is!" Qian Fangzhao replied, "In addition to B-ultrasound, CT enhanced scan and PET-CT can detect liver abscesses." ”

"I understand, thank you Dean Qian!" Ren Jiangchi turned his head to look at Zhou Rujun and Zhao Kaiming, "Director Zhou, Mr. Zhao, I hope you can immediately request a CT enhanced scan or PET-CT examination for Dongdong!"