This patient may not only have bleeding from the upper gastrointestinal tract, but may also have bleeding in a certain part of the lower gastrointestinal tract.

And the source of the major bleeding is most likely in the lower gastrointestinal tract.

When Zhou Can made the first diagnosis of this patient, hemostasis and pathological diagnosis were combined with two sixth-level medical techniques, and it was determined that the source of the patient's bleeding was in the upper gastrointestinal tract, and it was likely to be the stomach. Now, after further diagnosis, it was found that the patient was likely to have multi-source bleeding.

This indicates that his initial diagnosis was missed.

However, even if he missed the diagnosis, he also gained a lot and explored the diagnostic techniques of top doctors.

At most, his level of hemostasis and pathological diagnosis is still at a low level, and there is still a big gap between him and the real top level.

Therefore, there will be a missed diagnosis in the diagnosis.

In any case, just by examining the body and the patient's medical history and symptoms, a bleeding source can be roughly identified, which is already very good.

You know, he's only a resident now!

And it's just a low-seniority resident, it's already so powerful, as long as you study hard and practice hard, it's only a matter of time before you reach the top level.

I don't know how many times lucky I am than those doctors who have practiced medicine for most of their lives and have not even stepped into the director-level level.

"Okay, I'll immediately arrange for the patient to take gastric juice for testing, Dr. Zhou has worked hard, hurry up and eat!" If you have a new diagnostic idea, you can always tell me. In view of the seriousness of the patient's condition, I first asked the doctor from the Department of Gastroenterology to come for a consultation according to the procedure. ”

Ai Li has respect and concern for Zhou Canna from the bottom of her heart.

As a doctor, he can best know the suffering of doctors.

Zhou Can has been busy in the operating room all morning, and now she is still hungry to help her diagnose patients, which is a great love.

Elle asked a doctor from the Department of Gastroenterology to come for a consultation, and it is best to find out the cause, and if it can't be detected, it can also differentiate the risk. She is now very worried about the sudden deterioration of the patient's condition, and people say that it will be gone.

……

Sitting in the cafeteria to eat, Zhou Can's mind was still thinking about the cause of this patient.

Gastric juice is aspirated for testing, and if the test result is non-bloody, then it is definitely necessary to check the lower gastrointestinal tract.

The likelihood of acute hemorrhagic necrotizing enteritis is very high, given that the patient has a febrile response and also has hemorrhagic overdose shock.

When Zhou Can examined the patient's abdominal tenderness, he pressed the patient's xiphoid process below and around the navel, and the patient had an obvious tenderness reaction.

Acute hemorrhagic necrotizing enteritis, often with symptoms such as periumbilical and abdominal cramps, bloody and watery stool, and even necrotic and necrotic intestinal mucosa, the stool will be particularly fishy.

Among the above symptoms, except for gastrointestinal bleeding and periumbilical pain, other symptoms were not found.

Therefore, acute hemorrhagic necrotizing enteritis cannot be ruled out and cannot be fully diagnosed.

At most, it is a 50% chance of being diagnosed.

This requires further observation and stool testing.

If this disease is ruled out, what will it be?

At this time, Zhou Can deeply realized that when the book is used, there is less hatred.

Searching the intestines and scraping the stomach screened the cases and knowledge points of digestive tract-related diseases one by one.

He is already powerful, at least a hundred times stronger than those medical students who have an empty stomach of medical knowledge, but when it comes to clinical practice, their brains are blank, and they can't use a single one.

This kind of paper talk is particularly powerful, and there are many doctors who get high scores in exams time and again, but there are not a few doctors who become cowards as soon as they enter the clinic.

That's how everybody came along.

Slowly, I have more actual combat, and with experience, I know how to apply what I have learned.

After one year of internship, three years of regular training, and nearly two years of residency work, Zhou Can has a wealth of practical experience. It is completely possible to apply what you have learned.

At this time, he thought of a disease that was similar to the patient's symptoms.

Ulcerative colitis.

This is a nonspecific inflammatory bowel disease that tends to have a slow onset.

The onset of the disease was also very slow, and the course of the disease lasted for more than a month. This is very much in line with that.

The location of the lesion is also matched.

The lower gastrointestinal tract includes the colon.

Moreover, Zhou Can learned that after the patient used hemostatic drugs and 1000 ml of blood transfusion, the symptoms of anemia did not change, and he already suspected that the possibility of bleeding in the small intestine or upper colon of the patient was extremely high.

Ulcerative colitis is often accompanied by diarrhea, abdominal pain and other symptoms, followed by bloody stools, even pus and bloody stools, and also accompanied by fever and weight loss.

Among these symptoms, the patient had abdominal pain, bloody stools, fever, and weight loss.

A slow course of disease is also commensurate.

So the likelihood of ulcerative colitis is very high.

Zhou Can had already come up with two possible diseases, and he was not satisfied.

A truly top-notch doctor is one who constantly expands his diagnostic thinking and takes into account all possible causes.

The more comprehensive the thinking, the better.

When diagnosing a patient, it is very important to test the amount of knowledge and clinical experience of a doctor in the relevant field.

This is also the reason why experts are 'from the beginning', and few people are able to blossom in multiple fields at the same time. Because a person's energy and time are really too limited.

Zhou Can has trained in gastroenterology and digestive surgery, and the time is not short.

This also gave him the opportunity to accumulate more experience in the diagnosis and treatment of digestive diseases and learn more related knowledge.

At this time, two new diseases popped into his mind.

Colonic diverticular disease, which occurs mostly in the sigmoid colon and cecum, is often accompanied by fever, elevated white blood cell count, and signs of peritonitis.

The disease is characterized by periodic small bleeding or acute heavy bleeding.

Another disease is Merkel's diverticulum.

The basic symptoms are similar to those of colonic diverticulosis, except that they are more common in the terminal ileum.

The patient has fever and acute massive bleeding, which are two points that are correct.

However, no signs of peritonitis were found.

Both of these conditions are possible, but not very likely.

Zhou Can has already figured out four causes, but he is still not satisfied, and he is still racking his brains to think about it.

"Hey, Xiaolan, you're eating here too!"

A magnetic man's voice sounded, and Zhou Can was awakened from his contemplation.

"Yes! We were very busy this morning and just had surgery. Have you eaten it? ”

Ma Xiaolan responded with a bright smile.

"I'm a little busy today, no, I'm just going to come over for a bite to eat. Is it convenient to share a table with you? Dr. Chow! ”

The man who greeted Ma Xiaolan asked Zhou Can with a smile.

"You may be seated! Dr. Du and Xiaolan have known each other for a long time? ”

Zhou Can didn't expect to meet Du Leng here.

Because he is very busy with work, he often orders meals in the operating room and rarely comes to the restaurant to eat. The number of encounters with Du Leng is also only a handful.

In addition, Zhou Can's current status has thrown Du Leng out of several streets, even if they meet, Zhou Can is also a king.

Du Leng tried not to greet him head-on and avoided him.

Why?

Because a doctoral student who graduated from a prestigious overseas university was crushed by an undergraduate student from a domestic 985 university, it is a shame!

Don't look at Du Leng's usual gentleness and elegance, he looks humble and gentlemanly, but he actually has a fight with Yue Buqun in martial arts dramas. Not only is he hypocritical, but he also wants to save face.

What impressed Zhou Can the most was that he went to Xinxiang Women's and Children's Hospital with Du Leng a few years ago.

Zhou Can fought out like a peerless dark horse, and Du Liang fell off the altar.

After the expert consultation, Du Leng began to deliberately avoid him, and began to start from the basic clinical work in a down-to-earth manner. It is said that he learns the same way to give the patient feces and urine, change the dressing, and lower the urinary tube.

As for Du Leng's current strength, Zhou Can really doesn't know.

In terms of surgical talent, Du Leng is not as good as Zhou Can even if he flies.

"I've known Dr. Du for about three months. One day when I got off work late, it happened to be raining again, and I couldn't get a taxi, so Dr. Du offered to take me back to my accommodation. ”

When Ma Xiaolan talked about this incident, she was full of gratitude.

At the same time, I was a little embarrassed.

Women's touches often happen when they are in trouble.

For example, when they are robbed by gangsters, entangled by street runners, or sick and need to be taken care of, when they are most helpless, there are men who lend a hand, and nine times out of ten they can leave a deep good impression in their hearts.

Some wonderful fates often start with such small things.

"Are you two dating or ordinary friends now?"

After listening to this, Zhou Can asked with a smile.

"As the boss of the surgical team, Dr. Zhou really cares about the team members! Even these personal matters should be inquired into in detail. ”

Du Leng hurriedly spoke out to relieve Ma Xiaolan.

"Haha, everyone has a heart for gossip, I am also a layman, but Dr. Du thinks too highly of me. Dr. Du has a dazzling academic background, looks like a talent, and must have talked to a lot of girlfriends. I have to say hello and not let Xiaolan down, otherwise everyone in our surgical team won't agree. ”

Zhou Can said half-jokingly and half-seriously.

The main thing is to remind Ma Xiaolan that she doesn't know if she is being played.

Du Leng's reputation is not very good.

There are at least ten female doctors and nurses who have been played by him in the hospital. However, Du Leng's ability must be admired, so far, none of those female doctors and nurses have made trouble.

I heard that Du Leng chooses a girlfriend, and the requirements for the face only need to be at the upper middle level, but he attaches great importance to the figure.

It can only be said that everyone's hobbies are different.

Ma Xiaolan has known him for three months, and it is unknown how far he has developed with Du Leng.

As the boss of the surgical team, Zhou Can can only fulfill his obligation to remind, and he will definitely not interfere with the doctors and nurses under him in love.

"Is Dr. Zhou praising me, or is it hurting me? Du someone is not as attentive as you say, I am drowning 3,000 and only take one scoop of drink. If one day, I find a girl who can make my heart move, I am willing to be like the love of a white swan, and never give up. ”

Du Leng didn't know if he was worried that Zhou Can would mess up his relationship, or what.

Quickly made a serious statement.

It's more like expressing his view of love to Ma Xiaolan.

I don't want to be mistaken for a big carrot by her.

His explanation of being so anxious confirmed that the two were in love.

Judging from the performance that Du Leng cares about so much, it is speculated that he should not have been able to take down Ma Xiaolan yet. Of course, it is also possible that he has already won it, maybe he really likes Ma Xiaolan, so he cares so much.

Whether it is a man or a woman, when you meet someone you like, you are often easy to become infatuated.

One thing descends one thing.

"Hurry up and eat, or the rice will be cold!"

Ma Xiaolan played a round for the two.

During the meal, Du Leng did a very interesting thing, and when he was about to eat, he quickly got up, ran to the window and bought a few bottles of yogurt.

One bottle per person.

Zhou Can felt incredible, what did this guy want to do? Engaging in bribery?

"Thank you Dr. Du for inviting us to drink yogurt, it's not too early, we have to go back to work in the operating room, goodbye."

As the boss of the team, Zhou Can must have something to say.

"You're welcome! In fact, I admire you a lot, it is said that your surgical ability is no worse than that of senior chief physicians in many fields, which is simply a miracle. I'm sure God must have touched you. ”

Du Leng didn't look like a hypocrisy and politeness at the moment, but spoke in a more serious tone.

"Hehe, Dr. Du admires me, but I don't know that I admire you even more! Overseas students are already powerful enough, and there are definitely only one or two people out of tens of millions who graduated from famous overseas schools. Also, I never believed in God, my faith was Yanhuang. ”

Zhou Can never does anything other than worship foreign charm.

In terms of mythological system, how can foreign Athena, Lady Liberty, God, and Satan compare to the Chinese mythological system?

The Three Qings of China, the Jade Emperor, the major star monarchs, the major heavenly kings, the dragon kings of the four seas, etc., is a very complete mythological system. It has a complete division of labor and a clear analysis of the status and level.

Du Leng suddenly said that he admired him very much, what kind of medicine is this guy selling in his gourd?

Is this trying to take the initiative to shake hands and make peace?

In the past, Du Leng and him were like fire and water.

After coming out of the cafeteria and on the way back to the emergency department, Zhou Can began to think about what other possible causes of the patient with gastrointestinal bleeding were.

Intestinal malignant histiocytosis.

Another disease that was more consistent with the patient's symptoms was screened out by him.

It is often accompanied by fever and gastrointestinal bleeding, and antibiotic therapy is often ineffective.

The patient's condition is highly consistent with the disease.

The best way to confirm the diagnosis is to have a barium gastrogram or an emergency endoscopy.

However, the patient has just come out of shock, his body is still very weak, and there is likely to be a lot of blood in the intestines, and the effect of these two tests will be greatly reduced.

It may be a good idea to give the patient a routine bone marrow test.

Zhou Can had already walked to the hall of the emergency department at this time.

"Doctor Zhou, Director Han, please go to the consultation room to discuss your condition."

When the nurse saw Zhou Can, she hurriedly stepped forward to tell her.

When he came to the consultation room, Zhou Can found that Ai Li, Deputy Director Han, and Director Shang of the Department of Gastroenterology were also present with two students.

"Yo, I haven't seen Dr. Zhou in a few days."

When Director Shang saw Zhou Can coming in, he immediately stood up and took the initiative to walk over and shake hands with Zhou Can warmly.

Look at Director Shang's attitude, he didn't treat Zhou Can as a resident at all, but raised it to the level of an old friend at the same level as him.

"Haha, I haven't seen you in a few days. Director Shang's complexion is even better. ”

Zhou Can responded enthusiastically, and even flattered the other party.

(End of chapter)