Since 1981 Health School Chapter 509

   Both Chen Qi and Qi Damin believed that this patient should have upper gastrointestinal bleeding, and the most likely site was gastric bleeding, which is also common in clinical practice.

  Especially this type of middle-aged women, who have come here hungry in the past few decades, and seldom have a full meal, so the proportion of stomach problems is quite high.

  Wang Fang shook her head lightly at this time:

   "The strangest part is here. We have already done a gastroscopy, and no bleeding point was found in the stomach or esophagus, so now we can't determine where the bleeding site is."

   "Hey, this is strange. He vomits blood and black stools, and the symptoms of upper gastrointestinal bleeding are very obvious. The lower gastrointestinal tract should not be vomiting blood, at least he must vomit feces or intestinal contents."

   At this time, a staff member of the medical department raised a question.

  Wang Fang gritted her teeth, her little face blushed a little:

   "We, we think that the possibility of lower gastrointestinal bleeding also exists, so we also had a colonoscopy yesterday, but also found no problems."

  The patient's family members were dissatisfied after hearing this:

"Doctor, I'm not bleeding from the upper or lower gastrointestinal tract. Where is the bleeding? Could it be that you can't find it? I came here from Yongbo City. I heard that your Yuezhong People's Hospital digested The level of internal medicine is so good that I came here to seek treatment, but it turned out that I couldn't even determine the bleeding site, this, this is too much, right?"

  The words of the family members are equivalent to slapping the doctor in the face.

   It was still Lan Lijuan, the new director of the department who was slapped in the face. If word spread that even a single stomach bleed could not be cured, the colleagues would really laugh out loud.

   Qi Damin stood behind, watching with cold eyes, wanting to see how the couple deal with this difficult problem.

  Lan Lijuan glanced at Chen Qi, and Chen Qi also looked over at this time, and the two said in unison:

   "Do another gastroscopy."

  Who knows that the patient is dissatisfied:

"Doctor, don't do a gastroscopy, it's too uncomfortable. I kept vomiting after the gastroscopy, and I'm going to be stabbed to bleed. Besides, it costs 20 yuan to do a gastroscopy, which is half a month's wages for me. , don't do it, don't do it.”

  Do not do gastroscopy? Then the treatment is the blind man touching the elephant, and it will really overturn.

  Chen Qi had to come forward:

"Sister, let me tell you, our stomach is like a cloth bag, filled with things, it is like a bulging balloon. However, fasting is required for gastroscopy. If there is nothing in the stomach, the stomach will shrink. It is so small that the stomach wall is folded.

  The gastroscope relies on a camera at the top, and pokes it into your stomach. If the bleeding point is just in the corner, or just in the folded part, it is normal that it cannot be detected. You see, you have black stools, which means that the bleeding has not stopped.

  The bleeding in the stomach is uncontrollable, do you know what will happen? That is gastric perforation, which is serious. At that time, an operation will be required to open the abdominal cavity and cut off part of your stomach. Think about it, how much damage will this do to your body, right? "

  Patients and family members are easy to fool. These days, there are no mobile phones, no Baidu, and doctors usually do what they say.

   Frightened by Chen Qi, the patient nodded repeatedly:

   "Hey, the doctor is right, let's continue to check, but it's not justified if it can't be checked again this time."

  Lan Lijuan was about to speak, but Chen Qi spoke first:

   "Okay, this time I will perform the gastroscopy myself to ensure that the bleeding point is found."

   Nonsense, of course he has to stand up for his wife at the critical moment. Chen Qi feels that it is his duty to do so, and it is also related to his sexual life after returning home.

   Lan Lijuan was obviously very satisfied with her husband's performance, and said with a smile:

   "Then please, Dean Chen, teach our gastroenterology doctors a good lesson today."

  The middle-aged woman and her husband hesitated after seeing Chen Qi: "This doctor looks very young, is he an intern or a junior doctor?"

  Liu Huichun only spoke at this time:

   "Hey, you've misjudged this. The person in front of you is a true Buddha. He is the director of two international medical associations and the president of our People's Hospital."

   "Ah, so young to become the dean? It's not a few years older than my son."

   "Okay, the level of being a dean must be good, then let's do this gastroscopy."

  Wang Fang was quite clever, and when she heard that the patient was willing to review the gastroscopy, she hurriedly pushed the gastroscope into the ward.

  The head nurse also quickly took the isolation gown, mask and hat, and put them on for Dean Chen herself. Look, this is the dean's treatment.

   Qi Damin looked sour from behind.

  All the preparations are ready, and Chen Qi also stands on the right side of the patient, ready to start the gastroscopy.

  As soon as I heard that the dean was going to do a gastroscopy in his ward rounds, no matter whether he was curious or flattering, all the doctors in the Department of Gastroenterology rushed over anyway, so he didn't care about the morning ward rounds.

  Chen Qi will insert the tube from the patient's mouth, all the way through the throat, esophagus, stomach, and duodenum.

  So everyone is staring at the TV screen. This gastroscope is sponsored by the Swedish Asrila Pharmaceutical Company for the Helicobacter pylori treatment research group. It belongs to the most advanced gastroscope in this era, and there are few in China.

  From then on, the doctor no longer needs to squint at the tube like a SLR camera when doing gastroscopy.

  Chen Qi lowered the pipe very slowly, inspecting every inch carefully.

  The esophageal mucosa is still very clean, and there is no rupture of esophageal varices. It is definitely not a problem with the esophageal veins. This part is ruled out.

   Immediately after that, there was some blood in the stomach, which seemed to be old bleeding, because the color was wrong, it was dark red.

  Chen Qi held the gastroscope tube, turned left and right, watched and rinsed repeatedly, but checked up and down, inside and out, and found no obvious bleeding focus.

   At this time, a little doctor couldn't help exclaiming: "It's really not stomach bleeding."

  Chen Qi was also scratching his head at this time. In fact, he was confident at first, thinking that the bleeding point must be in the stomach. Now it's all right. The new director and new official overturned on the first day of taking office.

   Isn't this a big joke.

  Chen Qi still did not give up, and said to Lan Lijuan next to her:

   "Don't worry, let me see the duodenum again?

  A gastroscope is a gastroscope in name. In fact, in addition to being able to see the esophagus and stomach, it can also be extended to see the duodenum below.

  The name of the duodenum is very strange. In fact, the origin of the name is also very simple. It is a section of intestines connected under the stomach. Because this section of intestines is as long as the surgeon's twelve fingers are juxtaposed, it is named duodenum.

   This is also the most prone to ulceration and bleeding.

  If the patient does not have a gastric ulcer, she probably has a duodenal ulcer, otherwise there is no way to explain her bleeding.

   But after repeated careful inspection, Chen Qi almost broke the endoscope tube, and there was no obvious bleeding focus in the duodenum.

   Looking at it along the way, apart from a little gastritis, the patient is far from an ulcer, and there is no way to explain the bleeding.

what happened?

   Could it be the small intestine bleeding deeper below the duodenum? Chen Qi was puzzled.

  It was quiet in the ward, and many little doctors had already quietly hid away, fearing that the dean would get mad later and they would become cannon fodder.

  Liu Huichun seemed more anxious. Although she is not a doctor, she still has basic common sense in the hospital for so many years.

   In case Dean Chen fails the ward round today, although it will not affect his position as dean, it will still deal a big blow to Chen Qi's personal prestige. After all, so many people watch Dean Chen's good show.

  Qi Damin appeared calm and calm on the surface, but in fact he was already happy in his heart.

   This overturn not only hurt the reputation of Lan Lijuan, the new director of the department, but also hurt the reputation of the new director, Chen Qi, as a "miracle doctor".

  Chen Qi came to the stage, the main highlight is that he can see a doctor, he can see a doctor, and he can see a disease that others can't see.

   Now it's healed, and I can't even diagnose a gastrointestinal bleeding. In the future, I'm ashamed to say that I'm the best in medical skills, and I'm ashamed to say that I'm an international double director?

  Chen Qi didn't think so much, or he didn't think about what the consequences of this overturn would be like.

  Seeing a doctor is just seeing a doctor. It should be pure, and should not be mixed with too much fame and fortune, let alone refraining from taking care of feathers. This is what old experts and professors will do.

  He is still young, 26 years old, if he makes a mistake, he will make a mistake, and there is always a chance to start over.

  Lan Lijuan reminded at this time: "Dean Chen, are you considering another colonoscopy?"

  Who knew that the patient's family members became irritable when these words came out:

"Don't do it, don't do it, colonoscopy is even more painful. Will you see a doctor? It seems that the dean is nothing more than that. You Yuezhong don't know how to do it. Let such a young man be the dean, it must be Backdoor goods, the level is too poor."

  The patient was speechless with a gastric tube inserted in his mouth at this time, but his eyes were full of doubts, and he motioned to pull out the gastroscope quickly.

  As soon as these words came out, Qi Damin really couldn't help wanting to cry up to the sky.

  The other little doctors lowered their heads one after another, not daring to breathe.

  Chen Qi didn't care what others were saying or thinking, all he thought about was how to find the real cause of the disease.

  If it is necessary to determine whether it is the small intestine bleeding below, there are two other ways to go to the hospital in his previous life.

  One is to do capsule endoscopy, swallow a capsule with a camera, the capsule enters from the mouth, passes through the intestinal tract, and then is discharged through the anus. If there is bleeding in the middle, the capsule endoscopy can see it.

   But this is the 1980s, even if he has the capsule in the operating room, he dare not take it out.

   Besides, the capsule gastroscope can only see if it can be treated, even if the bleeding point is found, there is no way to deal with it.

   There is a second way, which is to send it over for interventional treatment. Through angiography, intestinal vascular bleeding may be found.

  Anyway, that's something for another time. It's embarrassing that the current gastroscopy didn't find any problems.

  Chen Qi is not a god, he sighed, and cursed secretly in his heart, expressing that he admits he was wronged, and was about to exit the mirror and return angrily.

   At this time, not to mention the silence in the ward, it seems that the entire Sixth Internal Medicine Department is terribly quiet.

  The little nurses outside hung the needles and walked lightly. The atmosphere was so solemn that some little nurses hid in the dressing room and dared not come out.

  Chen Qi glanced at the stern faces of the people around him, and smiled instead:

"Don't be so nervous. Gastroscopy is good. This is not a bad thing. At least we have ruled out the cause of upper gastrointestinal bleeding. Next, we will focus on checking the lower gastrointestinal tract. You see, the scope has narrowed, and it is far from the truth." One step closer."

  He took another look at the angry faces of the patient and his family members, and comforted him patiently:

"You guys, don't worry. Medicine is like this. If this road is blocked, let's change another road. The disease will definitely be cured for us. If it can't be cured, we won't charge for the medical expenses. By the way, the cost of this gastroscope is 100%. Let it be reduced."

  Doctors are most afraid of patients going crazy, and the impact will be bad if they make a fuss at that time. If they go out, the new dean + new department director can't even handle gastrointestinal bleeding?

  Chen Qi was also afraid, so he could only appease the middle-aged couple first.

   Sure enough, after hearing that the gastroscopy fee was waived, the faces of the patient and his family members looked much better. They felt that they were a little bit cheap and saved 20 yuan, so their anger was also smooth.

  But now it is not a question of money or not, but the problem that should be solved is still not solved.

  At this time, the electronic gastroscope exits from the duodenum all the way through the stomach, esophagus, throat, and oral cavity

"etc."

  Lan Lijuan discovered the problem, she pointed to the electronic screen, and looked back at Chen Qi:

   "See, there is blood in the patient's mouth. It was clean when I first entered. This is problematic. Could it be the patient's mouth bleeding?"

  Hearing this sentence, all the doctors in the ward widened their eyes.

  Chen Qi also got serious, picked up the gastroscope lens and scanned the patient's teeth a few times.

   Sure enough, it was found that the innermost molar on the bottom left of the patient's tooth was bleeding continuously, and that tooth was probably carious.

  Chen Qi and Lan Lijuan looked at each other, they both breathed a sigh of relief, and then smiled tacitly.

  Seeing the bleeding point, although the bleeding point is not in the digestive tract as expected, but I probably know what the cause is, and there is a high probability that the car will not roll over.

  The dentist came quickly, the old director Tang Weiyang.

  Director Tang obviously heard that the dean was doing ward rounds, so the veteran went out in person, which actually meant flattering the new dean.

   "President Chen, hello, I am Lao Tang from the dentistry department. I heard that there is a consultation here. Didn't I come here in person, ha ha."

  Chen Qi also smiled:

   "Director Tang, don't be too polite. You don't know me, but I know you. When I was an intern, I have admired your name for a long time, hehe. Let me briefly introduce this patient.

  The patient has hematemesis and melena, but currently has no stomach pain or abdominal pain. We have done gastroscopy and colonoscopy and both showed normal, no obvious bleeding points. However, during gastroscopy, it was accidentally discovered that the patient's gums had been bleeding.

  So now we suspect that the patient's hematemesis and melena is not caused by gastrointestinal bleeding, but a lot of gingival bleeding, so we want you to help with the consultation and check. "

  When Director Tang heard such a simple consultation, he patted his chest with confidence:

   "Small idea, leave it to me, I promise you won't go on a business trip."

Chapter end