"Is there an MRI in the photo? If there is only CT, it is almost impossible to see. ”

"What MRI shows is much finer than CT. CT is actually better at looking at large organ injuries such as organ injuries and fractures. Fang Xian did not refuse.

When you first arrive, you enter a department, not an intensive training in the operating room, so you must have to contact patients, have colleagues, and deal with certain interpersonal relationships.

During the training period, Fang Xian only needs to learn, just need to ponder!

The diagnosis does not need Fang Xian to be responsible, the prognosis does not need, the choice of surgical methods does not need, and the overall progress of the operation does not need Fang Xian to worry, what he wants to do well is his own work, study, and strive to grow.

"Yes, Doctor Fang, look here......" He Donglai immediately called up the results of the MRI and moved out of the way.

He Donglai and Huang Qian hurriedly stood on the left and right sides of Fang Xian, rolling the mouse with Fang Xian, while bending down and prostrate, aiming their butts at the desk behind them, carefully and seriously.

In order to ensure that Fang Xian can read the film more accurately, He Donglai also took the initiative to help explain: "This patient has a blunt trauma to the upper abdomen, the skin is bruised, but the skin is not broken, the ribs are broken, and the MRI shows that the pancreas is ruptured, the liver and the spleen are contusion. ”

"Then the abdominal aorta is completely disfigured, there is no large amount of ascites effusion, the damage of large blood vessels is not considered for the time being, the spleen is irregular, there are diffuse hemorrhage spots around the pancreas, and there are blood clots, you see these locations......"

"But during the operation, there was arterial bleeding. We still haven't completely figured out which artery is bleeding, and Director Fang didn't say, let's review this case again and do a review of the condition in the department tomorrow. ”

"Now the two of us are also feeling quite a headache." He Dong finished speaking, and turned his head to look at Fang Xian.

It is not only a quest for advice, but also a discussion.

Fang Xian just glanced up and down a few times, and then said, "The characteristics of normal pancreatic tissue in MRI are mainly in the following aspects——"

"The first is high contrast, and you can see whether it's a normal pancreas or a contusion: the pancreas usually has a high contrast on MRI and is clearly separated from the surrounding tissue, which is very helpful for our clinicians to have a clear view of its shape and structure."

"It's much more convenient than a CT scan."

"The second one, like CT, can be multi-plane imaging, which is the basic feature of MRI, and we won't mention it first."

"The third is that the resolution of soft tissues is good, in addition to seeing the general structure of the pancreas, we can also use MRI to present the characteristics of soft tissues, and we can see the internal structure of the pancreas, including the pancreatic duct system and the pancreatic parenchyma."

"Of course, functional imaging is not necessary, and this is not a diabetic patient to assess islet function!"

"Really?" Fang Xian first found a part of the pancreatic normal tissue imaging map and introduced them to the two of them.

When they heard this, they both nodded, but their brows were furrowed.

Because the content that Fang Xian is talking about is actually a bit high-end.

According to the report, the general location of the injury is the content mastered by the level 1 MRI reading, and the level 2 MRI reading needs to accurately locate the location of the lesion, make its own interpretation, and conduct a qualitative analysis of the nature of the lesion.

Level 3 MRI requires an understanding of anatomical structures, such as the head, body, tail and fine structure of the pancreas, which requires a certain foundation in anatomical structure.

This is already the limit of the two.

As for what Fang Xian said, the so-called pancreatic duct system and pancreatic parenchyma, this is already the content of the MRI reading level, which is more refined.

However, you have to learn first, and find the key points first.

Therefore, even if the two of them understood only half of it, they digested part of it and did not interrupt.

"Once we've found the location of the injury, we need to go through the MRI and the patient's general medical history to understand the approximate nature of the injury."

"Contusion, the doctor in the imaging department has given us guidance, and the report also shows it. However, the doctors in the imaging department will not do more in-depth interpretation, and these need to be done by our clinicians in combination with clinical practice——"

"The patient's operation is over, right?" Fang Xian interjected.

If the patient is still on stage, then he will not talk nonsense and go straight to the point.

The patient has been properly managed, and when the case is retrospectively dissected, Fang Xian can speak more deeply so that the two of them can learn to understand.

If the patient is still on the stage and there are some mistakes that have not been discovered, then give a fart lesson and hurry up to the operation.

"It's done, Director Fang just went down and finished it, and the patient has been transferred to the general surgery ward. You don't even need to go into the ICU. ”

"Director Fang's skills are still very good." Huang Qian nodded hurriedly, he was in the ward, and he was also responsible for the final whereabouts of the patient, and got in touch with the transfer department and explained some detailed questions.

Fang Xian also knew that his worries were too much, so he said again:

"According to the radiologist's direction, combined with the basic theory of general surgery, pancreatic contusion refers to external trauma or injury to the pancreas, usually accompanied by bleeding or inflammation."

"If it's a rupture, it's a direct burst open, not a contusion, and this definition must be like this."

"Two brothers, don't blame me for being too talkative, I mainly haven't lectured to others, and I have no experience in this area, so I strive for everything in every detail, and I used to be a student."

This is Fang Xian's truth.

It's been a long time since anyone has discussed with him how to diagnose and how to read films, and when Fang Xian was in the specialty, it was even more impossible to guide others.

And when the operation is pointed, it only needs to be improvised, to ensure that the lower limit of their operation level is pointed out.

However, the study of theories and the content related to diagnosis can naturally be more detailed, so that others can better understand. Fang Xian had no experience in this area.

"Well, it's okay, Doctor Fang continued." He Donglai and Huang Qian also hoped that Fang Xian could speak in more detail, and the lecture that he could understand was the first priority, rather than pretending to be profound.

"Edema and swelling: After trauma, the pancreas will definitely experience edema and swelling, which may manifest on MRI as an increase in the volume of the pancreas. That's understandable, right? ”

"Whether it's surgery or a sprain, there's swelling. Swelling is a three-dimensional alteration of volume. Visible to the naked eye, the display on the MRI will definitely not let go of these changes, right? ”

"So, whether it's the pancreas or the swelling after blood vessel damage, there will be a migration of thickness with other normal tissues—"

When Fang Xian said this, he also made a trapezoidal gesture with both hands, representing the gradual increase in the trend.

The two continued to nod.

Fang Xiancai said again: "Then, on this MRI image, we can't see similar content on the pancreas, because there is extensive edema and swelling. ”

"But based on this theory, let's push the blood vessels out of shape—"

Fang Xian suddenly changed another organ, jumping from the pancreas to the blood vessels.

"This is the abdominal aorta, this is the wall of the aorta, and it's out of shape, from top to bottom, uniform, right?"

"This means that it's either generalized edema or normal, otherwise it won't be so even. During the operation, we found that the blood vessel wall must be good, otherwise, the rupture of the abdominal aorta, such bleeding, the patient may be gone in half a minute. ”

However, when we look for it again according to such a trapezoidal change, we will find out. The abdominal aorta supplies several branch blood vessels to the pancreas, and there are what we call a migratory change—"

"Here."

Fang Xian took the mouse and pointed -

"Celiac artery: The celiac artery is an important branch of the abdominal aorta that supplies the head blood vessels of the pancreas. This branch is also known as the mesenteric trunk, and when it passes from here, it remains uniform in the walls of the blood vessels. ”

"It divides into several small branches, one of which is the pancreatic artery, which is responsible for supplying blood to the head of the pancreas. Over here. Fang Xian flipped up and down, striving to be able to show the two of them the cross-section of the artery.

After that, Fang Xian asked again: "Have you found such a trapezoidal structure?" ”

"Damn, it turned out to be here. Edema? ”

"It's just that there was no rupture and blood leaking at the time." He Donglai suddenly realized and patted his head.

"Yes, after edema, the wall of the blood vessel will become brittle, and in the case of fragility, if stress contraction occurs, it will rupture during surgery."

"However, it is not necessarily just this blood vessel that is broken, whether it is broken or not, only during the operation will be known."

"Let's look at the second artery of the trunk branch of the abdominal aorta, the superior mesenteric artery. It's here. The superior mesenteric artery in this patient is a classic branching structure with no errors or variations. ”

"Most of it goes towards the intestines, mainly supplying blood to the intestines, but it also sends branches to the pancreas to ensure the blood supply to the body and tail of the pancreas."

And, when we read, we will find, where is this trapezoidal structure? It's not on the veins of the pancreatic branches, it's in this location—"

"Trapezoidal or migratory structures, so that the walls of the blood vessels are uniform at both the proximal and distal ends, but they are prone to rupture here when the arteries are constricted, usually in the setting of ischemia."

"Thus caught off guard, if I speculate, the ruptured blood vessel is more likely to be this one."

"After all, if it is difficult to find the bleeding point during the operation, it is easy to find the rupture of the blood vessels close to the pancreas or supplying the pancreas, but the rupture of other blood vessels far away from the pancreas is difficult to locate!"

"When we see bleeding, we will subconsciously find blood spots nearby, and if we don't find it, it must be relatively hidden, right......"

Fang Xian was asking if it was right.

The corners of He Donglai and Huang Qian's mouths moved, but they didn't make a sound, as if they were doing the right thing to paralyze you, are you watching a film or a fortune teller?

Of course, Fang Xian said this, and they couldn't refute it at all.

They secretly sighed in their hearts that they didn't know how big the gap between TM's level 3 skills and level 4 skills was, but the gap between them and level 5 skills was like a desperate moat.

"Once we've found the edema, let's look at the hemorrhage: internal bleeding may occur with pancreatic contusion, and MRI can show signal changes in the bleeding area, which is usually low on T1-weighted images and hyperintense on T2-weighted images."

"This can be easily understood, the theory of MRI imaging is about the relaxation of H ions, in other words, as long as the content of H ions is high, such as fat, and water, the proportion of H ions is high, it will be high on T2 weighting."

"In the blood, the concentration of water is actually the highest substance."

"So according to this, let's look at it again, there is a broad contusion in the pancreas, and the contusion will seep blood, and the ascites accumulation below is not a clump, but linear, which means that the pancreas does not have extensive bleeding, or a large amount of bleeding."

"But behind the spleen, there is a clump of blood, which means that there may be a rupture in the cortex, which makes a large amount of blood spurt out, and this opening is not particularly large......"

"Of course, in fact, if we look back at the celiac artery and the superior mesenteric artery according to this injury symptom, we can find that in the transitional section of the superior mesenteric artery, there has been a rupture in the intima of the blood vessels, but the blood vessel wall and adventitial structure are temporarily damaged."

"There's a white triangular structure here, and it's not a neat triangle, which is supposed to be the ...... caused by blood washing after the lining of the blood vessel is broken."

"Then there's inflammation...... Inflammation triggered by a contusion may affect the tissues surrounding the pancreas, and MRI can show imaging features of this inflammation, such as swelling and enhancement. ”

After Fang Xian went deeper and deeper, the two began to listen to a book from heaven.

Therefore, after talking for a while, Fang Xian himself sighed and did not continue.

"Doctor Fang, thank you. It's amazing that you're able to read so much from this. It seems that there are too many points on the MRI that we have overlooked. ”

"That's a lot more informative than X-rays and CT." Huang Qian saw that Fang Xian stopped, so emotional, he confessed.

The attitude is unusually respectful.

Fang Xian shook his head: "That's not necessarily, if you look at it from the overall structure, the NMR is too detailed, and the control of the macro structure is not as good as the first two, but it looks better in detail." ”

"And if you want to find a wide range of damage locations at the beginning of the macro angle for reading, CT can omit many steps, and you can scan a lot of things at a glance, although it is blurry, but it can also help us doctors reduce a lot of unnecessary workload."

Although X-ray and CT are classic examinations, their usefulness is irreplaceable today.

For example, in reading liver cancer, intracranial hemorrhage, etc., it looks more comfortable than MRI, and some diseases that need to observe the general shape of the lesion are not particularly applicable.

For example, there are pros and cons to the lungs and heart, and there are many things that can be read on CT......

Lesions, nature of the disease, anatomy, global level, theory, etc.

While he was talking, Fang Yun returned to the office.

He Donglai hurriedly asked Fang Yun: "Director Fang, the point of sudden bleeding during the abdominal surgery done before is the non-pancreatic supply segment of the superior mesenteric artery, which is relatively hidden and cannot be found at the first time during the operation?" ”

Fang Yun was still carrying a person behind him at this time, probably in his forties.

When he heard this, he immediately blinked.

Fang Yun glanced at He Donglai, who was playful, and then looked at Fang Xian: "Did you help them read the film?" ”

Fang Xian blinked when he heard this.

He Donglai's eyelids collapsed slightly.

Facing Fang Yun, he didn't even have the courage and guts to lie.

"It's okay, this kind of disease is actually unusual and uncommon, you have to summarize it well, and now that you can see the anatomical structure, if you want to make progress, you must clarify the level, and even bring the theoretical part to the MRI reading."

"Theory is not to be memorized, but to be used, to be applied flexibly. When it is critical, it can help you solve a lot of troubles. Fang Yun didn't continue to criticize.

"Let's do your work first, eat all the cases encountered in the department, don't swallow dates, these cases contain a lot of technical things, if you can all have insight, the level will naturally improve."

"Of course, in the known situation, it is impossible for you to deduce from the beginning, but to extrapolate the opposite, put aside some things to deduce, so that you can gain something."

"Director Gong, I'm causing you trouble again, this time, the diagnosis of our trauma center is not thorough enough." After Fang Yun finished speaking, he apologized to Director Gong behind him.

But Director Gong immediately shook his head: "No, no, no, Director Fang, it's because I didn't evaluate carefully enough before the operation, so I'm causing you trouble......

"Fang Xian, you go back to eat first. Just come back tomorrow morning. ”

"I still have something to do with Director Gong." Fang Yun explained to the other party like this.

Fang Xian nodded, and also called casually: "Okay, Director Fang......"

Naturally, after Fang Yun took Director Gong into his office, Fang Xian naturally didn't leave directly. Instead, after asking Huang Qian and He Donglai about the personnel composition of the trauma center of the First People's Hospital of Changshi, he nodded.

There are not many people in the ward, and the chief surgeon in the operating room is mainly a small number of professors, and most of the deputy chief physicians are replaced by the deputy chief physician of the hospital when the surgery is consulted.

And this deputy chief physician, in fact, is the level certification of the medical association, and their real identity is actually the chief physician of the prefecture-level city hospital.

There is no way, if you want to strictly benchmark the level of the medical association, then many people really can't rise, and the treatment can't keep up. Therefore, when evaluating professional titles, the actual situation of this part will be taken into account in prefecture-level city hospitals and county hospitals.

When Fang Xian left, he glanced back at the First People's Hospital of Changshi.

I couldn't help but sigh slightly, and whispered: "Maybe I am not as experienced as other doctors in terms of diagnosis experience and reception experience, and my understanding of the mentality of patients and their families is not so mature." ”

"But my basic skills have come to the forefront."

"It's because I'm going too fast, so it's a little uneven now. But this imbalance is a good thing. ”

"I have high skills, but I don't have a lot of experience, so I can still make myself see a good doctor."

"Diagnosis and treatment, diagnosis first, and then choose the appropriate treatment method, should be attributed to the specialist, attributed to the specialist, can be solved with the basic skills of the specialist, can be solved with the basic skills of the specialist, and those who need the skills of the specialist, handed over to the doctor with the expertise to deal with the ......"

"This medicine is really a super huge system...... "Fang Xian's sense of expectation is even stronger.

(End of chapter)