"The patient's abdominal lymphadenopathy was swollen, coupled with cervical lymph node tuberculosis, I think there is some basis for the diagnosis of splenic tuberculosis in the second hospital during the follow-up."

Zhou Can said thoughtfully.

"Does Dr. Zhou also think that it is complicated by splenic tuberculosis? I also believe that this diagnosis is valid and that anti-tuberculosis treatment should be continued. Because tuberculosis is a chronic disease that is difficult to treat, it takes a long time to see the effect. ”

The attending physician, Huang Xinggui, spoke.

The treatment cycle of many diseases is very long, and tuberculosis is generally taken for more than half a year. Some patients are even seriously ill and need to take medication for a year or two.

"Uh...... I just think that the second hospital's re-examination diagnosis has some basis, but I don't agree with this result. The patient's initial examination results are very similar to tuberculosis, but the patient now reports occasional pain in the bones and joints of the whole body, which is actually a cause for alarm. When I was in orthopedic training, I came into contact with two cases of unexplained pain in the bones and joints, and both of them were finally diagnosed as malignant tumors. ”

Zhou Can trained in many departments, and all of them followed the chief physician, and the benefits gradually began to appear.

The so-called seeing more can be more knowledgeable.

He followed the chief physicians to diagnose patients, operated and treated patients together, and so many chief physicians taught him.

Although the total time of regular training is less than two years, the accumulation of various medical knowledge and clinical experience has been very considerable.

Especially in the diagnosis and treatment of incurable diseases, the diagnosis and treatment experience and knowledge of multiple departments are integrated, so that his diagnosis level is far beyond that of ordinary doctors. This advantage is not even comparable to many deputy chief physicians and chief physicians.

This is also why many chief physicians still try their best to study in other departments or even other hospitals after becoming famous.

Because they will clearly feel their lack of knowledge in their daily diagnosis and treatment.

In particular, the lack of medical knowledge and clinical experience in certain fields will become a shortcoming for them, seriously lowering their diagnosis and treatment level.

"Doctor, you're saying that my disease may be malignant, right?"

The patient's nerves immediately tense.

"Not necessarily, I just feel the need to do a CT and check the spleen area again. The ultrasound you did at the previous hospital can see multiple solid masses, but from the film, there should be a hypoechoic area or a low-density area, but it is not too obvious. ”

Zhou Can explained.

Without the final basis of the examination, he would definitely not dare to talk nonsense to the patient.

If you suspect that it may be such and such a disease, then there is nothing wrong with it.

When doctors diagnose patients, they are trying to separate the false from the true. Suspected diseases are screened and screened, and the real cause is finally left, and then the symptoms are treated.

B-ultrasound uses ultrasound to imprint the human body, while CT uses radiation to perform multi-slice tomography of the human body.

Different tissues and organs of the human body absorb X-rays to different degrees, and finally can form images with different densities. CT uses this principle to examine various organs of the human body, which has a higher resolution and more imaging information than ordinary X-ray examination for diseases of various organs, and has a greater role in disease diagnosis.

Many people think that CT is an upgraded version of X-rays, but this is not entirely true.

An X-ray scan is a planar projection of a part of the body, while a CT scan is a continuous multi-layered scan of a part of the body. The principle of imaging is not the same.

CT is a very good test to check for low-density areas in this organ.

In medicine, considering the affordability of patients, doctors often choose B-ultrasound and CT for clinical diagnosis. The results of the two tests can be referred to each other, which is of great medical diagnostic significance.

"Xiao Zhou's diagnosis level is getting higher and higher! It was basically the same as my diagnosis. This is a CT scan application, and you can pay for this scan. You don't have to queue up when you get the results, just come in and find me. I'm not here in the afternoon, but if it's too late, you can come to the inpatient department of the gastroenterology department. If I'm not there, you can find this Dr. Zhou as well. ”

Director Shang, this is the rhythm that completely pushed Zhou Can to the front line.

With such an honor, Zhou Can wanted to protest two sentences, but finally his lips moved and he swallowed the words back.

Seeing the inspection application form written by Director Shang, Zhou Can realized that Director Shang had already found out. It is to deliberately exercise the diagnostic ability of several of their students.

"Okay, thank you! Thank you Dr. Chow! ”

The family members took the inspection application form, thanked Director Shang, and thanked Zhou Can alone.

These two family members are also too realistic.

In fact, Huang Xinggui also contributed to this diagnosis, but they did not thank Huang Xinggui.

People are always concerned only with what is closest to their own interests.

Director Shang said that if he was not there, the patient would have to find Zhou Can with the test results.

Therefore, the family must have a good relationship with Zhou Can.

After the patient left, Huang Xinggui still asked with some puzzlement, "Director Shang, the patient's symptoms and existing examination results clearly indicate that it is tuberculosis!" Why do you and Zhou Chan suspect that a patient may have a tumor? ”

The other three graduate students were also quite puzzled.

Qiu Chengyu's eyes when he looked at Zhou Can were very complicated.

He watched Zhou Can climb rapidly from the status of 'doorman' on the first day to the current level step by step.

Today, Zhou Can's status has even surpassed Huang Xinggui, the attending physician.

Whether it is to send Zhou Can to the Department of Cardiovascular Medicine to replace Director Shang, or if the patient cannot find Director Shang just now, he can directly use the examination results to find Zhou Can for further diagnosis. It all shows that Zhou Can's status in Director Shang's heart has far surpassed Huang Xinggui.

You must know that before Zhou Can came, Huang Xinggui was an arm that Director Shang relied on very much.

Xie Lin and Luo Jingyi, two female graduate students, will consult Zhou Can privately whenever they encounter difficult problems.

Not for anything else, just because Zhou Can is the same age as them, and he is easy to talk to. And I can help them answer their questions every time.

"Xiao Zhou, you can explain their doubts."

Director Shang picked up the teacup and drank tea.

Teachers are very lazy, and they generally never contribute to the things that can be done for their doctors.

Perhaps the ancient Zhuge Liang had to bow down to everything, and the example of being tired to death left a deep impression on the world.

"I have three points of thought for diagnosis! First, the ultrasound of the spleen at the time of re-examination showed that there was a low-density area in the spleen, although it was not obvious, but it was a bad sign for tuberculosis patients and should be alarmed. Second, patients report occasional generalized bone and joint pain. This unexplained generalized bone and joint pain is equally dangerous and is often a precursor to leukemia and malignancy. ”

Zhou Can didn't hide it either, and shared his diagnostic ideas with everyone.

"Finally, the patient's bone marrow image is obviously hyperplasia, and the granulo-red ratio is 7 to 1, which is a little higher than the normal value, which is easy to ignore, but many malignant diseases will only be frighteningly high until they have developed to a severe stage. In the early days, it is mostly not obvious. ”

After saying three diagnostic points in a row, everyone was convinced.

Huang Xinggui suddenly realized, "I see, I see, Dr. Zhou not only has a solid medical foundation, but also is meticulous, and can also achieve the comprehensive application of medical clinical experience in multiple fields, I am convinced today." ”

"Hehe, Doctor Huang, these ecstasy soups have made my feet a few taels lighter!"

Excessive modesty equals pride.

Sometimes blind humility is easy to offend.

It's also pretty good to have a little humor once in a while.

Some people praise Zhou Can's solid medical skills, and this seems to be the first time.

It also shows that Zhou Can has achieved good results in making up for his medical knowledge in the past two years.

After the patient leaves, the patient continues to see the new patient.

The number released by Director Shang every time he sits in the clinic is basically fixed, but there are always some patients who have great powers, and after knowing that he is in the clinic, they try their best to find various ways to add numbers.

It was busy until it was almost 12 o'clock in the afternoon, and everyone here was ready to leave work, and the patient with an enlarged spleen rushed over after the examination.

"Professor Shang, the CT results are out, please help me take a look."

This patient was really amazing, and he actually lined up for an hour or so to finish the CT scan.

Director Shang took the film, and the CT results were much clearer than B-ultrasound.

Multiple areas of hypodensity in the spleen can be seen at a glance.

"The situation is not good, and I recommend a laparotomy to confirm the diagnosis. It is very likely that the spleen will need to be removed to save your life. ”

What Director Shang said this time was very serious.

The tone is also quite serious, and his face is full of solemnity.

At his level, he would not easily tell a patient to cut off an organ. You will only do this if you think it is very dangerous.

"Professor Shang, may I ask what is my mother-in-law's illness?"

The patient's daughter-in-law seemed relatively calm, and the patient's son was nervously supporting his mother, looking panicked.

"It is almost certain that there is a tumor in the spleen, and there is more than one. It's just that because it is hidden, and the presence of the tumor is hidden by lymph node tuberculosis, the first two hospitals have not been able to detect it. Taking advantage of the small size of the tumor, surgical solution is the best way to save life. The spleen is surrounded by important organs, and the lymph is dense, and malignant tumor cells are very easy to metastasize. Once it spreads, it's going to be troublesome. ”

Director Shang worked hard to persuade the family and the patient to agree to the exploratory laparotomy.

Remove the spleen if necessary.

This surgery will definitely have some effect on the patient's body, but it is much better than dying of cancer in the future.

Without this surgery, the tumor in the spleen may spread throughout the body in a maximum of two to three years.

At that time, the patient will not only live a very painful life, but also lose the opportunity to operate.

Medication can only be used as much as possible to reduce pain and improve the quality of the patient's late life.

"Isn't my mother-in-law tuberculosis? How did it become a spleen tumor? ”

It is still difficult for families to accept this fact.

"It is also very possible that tuberculosis has triggered a genetic mutation in malignancy. The older the patient, the more likely it is to have a genetic mutation. She now has two diseases, tuberculosis, and a large number of small tumors in the spleen. ”

Director Shang explained to her.

Doctors generally don't say the word cancer directly in front of the patient.

Replace it with a malignant tumor or a bad condition, a bad one, or something like that.

Oncogene mutations are an important cause of cancer.

Throughout a person's life, cells are constantly renewed. Every time a new cell is created, it will inevitably be accompanied by the replication of DNA and the transmission of genetic information.

We humans create more than 10 billion new cells every day, and it is inevitable that a certain percentage of wrong cells will be produced. Some of the wrong cells died, and some of the wrong cells gained infinite life and infinite ability to replicate. This is where the "cancer cells" come from.

When cancer cells appear, they do not necessarily develop into cancer.

Because our body also has a variety of protective mechanisms, the most important of which are tumor suppressor genes.

Only when tumor suppressor genes are lost or incapacitated, can cancer cells establish themselves in the human body and eventually become tumors.

Why are young people less likely to get cancer, while older people are at higher risk?

It is mainly because of the weakened immunity of the elderly.

Add to that the more cells are renewed, the higher the probability of errors.

It is unclear when the splenic tumor in this patient appeared. Some cancer cells can quietly lurk, develop obscenely, and wait patiently like Sima Yi of the Three Kingdoms. It is not until the patient's body has a defensive deficit that they take advantage of the situation and quickly grow into malignant tumors.

After listening to Director Shang's explanation, the two family members finally agreed to Director Shang's diagnosis and treatment plan of first exploring and then deciding whether to remove the spleen according to the situation.

Since surgery was involved, Director Shang directly recommended the patient to go to the Department of General Surgery for further treatment.

In general, if a patient who is not admitted to the hospital is not admitted to the hospital, it is usually recommended that the patient be transferred directly to the appropriate department for treatment.

Instead of using the medical resources of two departments, give the patient a multi-department joint surgery.

……

At the end of the consultation, Zhou Can and his colleagues went to the canteen to eat.

In contrast to the busyness of the surgeon, the internist, although also busy, is not so compact. Surgeons often take turns eating and often even miss meals.

A scene like an internist eating together is a luxury for a surgeon.

If you want to talk about the busiest department, surgery is not yet ranked first.

The busiest department is the intensive care department, which is a race against life all the time, and the doctors and nurses are always under tremendous work pressure. Rescuing critically ill patients with emergencies often requires many doctors and nurses to be busy and running.

That busyness, that nervousness, only the medical staff who have experienced it can understand.

While eating, Zhou Can's operation vibrated twice.

When he works in the hospital, his mobile phone is generally put on silent mode.

When I found it, it was a message from my girlfriend Su Qianqian.

"My dear, Hu Wei called me just now. He asked me to meet at John's Western Restaurant. ”

Since Zhou Can and Li Xuan finished talking, Zhou Can took a look at Su Qianqian's negative news on the Internet. It kept popping up like mushrooms after a rain, and the vast majority of the negative news was posted by a person with the ID name 'former employee of Golden Entertainment Interactive'.

The rest of the rumor-mongers are either just to win traffic, retweet without discipline or add fuel and vinegar to the fabrication.

Give a dog a bad name and hang him.

Su Qianqian must be under tremendous psychological pressure in the face of these rumors.

But she never took the initiative to mention it to Zhou Can.

The two had a tryst together, and she never reported good news or bad news.

Zhou Can knew in her heart that she was worried that after telling Zhou Can those things, it would affect Zhou Can's work. So she chose to suffer silently alone.

Of course, in the face of these rumor-mongers, as well as the surging pressure of public opinion, Jinyu Interactive will definitely not sit idly by.

In fact, Jinyu Interactive has long helped her secretly deal with those malicious slanders and rumors.

As her boyfriend, Zhou Can has every obligation to protect her woman from harm.

Stand up when she needs it most, and be her most solid backing.

For this reason, Zhou Can specially invited her to the dormitory two days ago and hugged her to talk about the matter.

In addition to comforting her, Zhou Can also thought of ways to help her.

Explain to her, as long as Hu Wei, the traitor who went out of Jinyu Interactive, calls her, she will immediately notify Zhou Can.

After waiting for so many days, Hu Wei finally couldn't hold back and took the initiative to contact her.

This also gave Zhou Can the opportunity to act according to the plan.

He wants to play general chess and fight Hu Haikun behind the scenes.

And what about the richest man? The foundation is not clean, and he is still making trouble everywhere, and he even wants to play yin to kick Zhou Can out of Jinyu Interactive, and now he has the idea of Zhou Can's girlfriend.

Zhou Can's policy has always been not to cause trouble and not be afraid of it.

Since Hu Haikun has stepped on his head to and pee, it is like cleaning up the money of the North Sirius Media Company, and directly sending this Hu Haikun to eat in prison.

This person has a criminal history of being involved in evil and crime, and the list of crimes is too numerous to mention, as long as it is verified, even if he doesn't eat guns, he has to sit through the prison.

"When are you going to meet?"

Zhou Can sent her a message back.

"Originally, I wouldn't have met with this kind of person, but you asked me to be a hypocrisy with this person, so I promised him to meet him tomorrow at two o'clock in the afternoon."

She has great trust in Zhou Can.

After Zhou Can talked to her that day, she was very useful in her heart. What woman doesn't want her boyfriend to protect herself?

Everything went according to Zhou Can's plan.

"Very good. If it's convenient, let Wei Fang come to me, I have something for her to do. ”

"Okay! After work, I asked her to wait for you downstairs in the dormitory. ”

"When it's time to ask her to call me. Also, when Wei Fang is not by your side, don't leave the company! Hu Haikun is a person who does everything, and he must be careful and careful. ”

Zhou Can told her.

In case Su Qianqian falls into the hands of such a person, he can think of it with his toes.

(End of chapter)