-- Lidawei / civil hospital of center of the store that be stationed in a horse digests internal medicine
Read clew: This draft is communicated come out a few meanings, one diagnose a disease is difficult, not be clutch points to calculate knew, train of thought of 2 diagnose a disease wants careful, logic is clear, 3 can examine gives patient disease is cure person the biggest happy event, this draft is not him boast the level is high, not be cure person light, be happy to behave expert of person of the same trade however. Of course, because this patient has fundamental disease, gastroscope checks family member apprehension, diagnose what also affected a doctor directly quickly.
How diagnose quicker
This is a male patient of 50 years old, begin before a month, the feeling is abdominal distension, did not cause his attention at first, but this is abdominal distension later heavier and heavier, bilge so that connect a meal not feel like eating went, and he himself discovers abdomen is bigger and bigger, the prefectural hospital that comes to his seat then sees a doctor, the doctor opened colour to exceed an examination to him, as a result discovery has a large number of ascites in abdomen, this can psych out patient and family member, then they are stationed in hospital of equestrian inn downtown to see a doctor rapidly, and lived in the hospital come down.
Because cause the cause of ascites a lot of, we did function of hematic convention, liver function, kidney, hepatitis to indicate content, bosom is abdominal to him early or late the examination such as content of mark of CT, tumour, as a result clew spends anaemia gently, albumin is a bit low, tumor indicates related enteron on the high side of content CA199, CA72-4.
This ascites reason still ambiguous, can you be malignant tumor? Lens of this stomach bowel has not been done, but, hear us to let him inspect gastric bowel looking glass, patient and family member feel very embarrassed! Because this patient is gone to already,once had had cerebral block medical history, return bequeath to have the trouble of limbs hemiplegy now, the heart plus him is bad, they are so special fear, anxiety-ridden, strong demand turns to provincial hospital to diagnose cure further.
Head Liang Baosong that visits people hospital to digest internal medicine to Henan in our Director Tang calls, contact this patient to turn examine when, bridge director says, his Zhou Er should come to our hospital to make academic communication, suitable path can diagnose tegether to say again first to this patient.
Zhou Er afternoon, be in hospital of center of the store that be stationed in a horse, professor Liang Baosong was done " enteron haemorrhage and proton pump depressor close manage application " lecture, after the lecture ends, the patient is accompanied by his son come to the assembly room, division of our hospital inside and outside, still have city of the inn that be stationed in a horse the director of digestive internal medicine of hospital of the first people and fellow people surround those who sit in bridge director all round.
Bridge professor says: "A moment ago, I told the clinical train of thought that enteron bleeds to everybody in the lecture, now, the diagnosis of the concerned ascites that my reoccupy myself sums up covers a region, operate actually with everybody, how do seeing me use a road to see examine. See examine at ordinary times, we need soon, ear listens, the mouth asks, nose is heard, still need serious medical, according to the analysis that cover a region, reach initial impression, choose necessary auxiliary examination again, again logistic thinking, discharge him to differentiate, just can reach next preliminary diagnose. Just can reach next preliminary diagnose..
Bridge professor says then: "Ascites, can classify according to the reason for 1. Heart source sex, 2. Liver source sex, 3. Kidney source sex, 4. Hidebound sex, 5. Peritoneal disease and systemic disease sex. This anaemia also has cover a region, can classify for 1. Hematopoiesis raw material is insufficient 1) do not have a meal to eat, 2) pharynx does not fall, 3) digest absorb an obstacle; 2. Exsanguine, 1) dominance is exsanguine, include haematemesis, haemoptysis, n/med having blood in one's stool, haemorrhage of hematuria, vagina, 2) recessive and exsanguine, include enteron tumour, substantial viscera tumour, verminosis and n/med tuberculosis to wait use up model disease; 3. Hematopoiesis dysfunction, include again barrier, leukaemia, medullary tumour and lymphatic tumour. I have a famous remark, be called old man anaemic have person or event associated with evil or misfortune surely! Be called old man anaemic have person or event associated with evil or misfortune surely!!
Then, bridge is awarded be examined in the assembly room and interrogation patient, discover the patient has gait of cerebral stalk sequela, anaemic appearance, although abdomen became big, but still have angular case, asked medical history in detail, main symptom, lasted how long, have liver medical history, have heart medical history, drink history, take medicaments history, have the n/med tuberculosis such as calorific, night sweat toxic symptom, these medical history are done not have, asked the reason of anaemic likelihood again, have not feel like eating, pharynx not to fall, haematemesis, black wait, again careful undertake examining system, consult examination result, one by one eliminates relevant illness, final consideration is malign tumor possibility is the largest, did detailed announcement to patient family member, need inspects gastric bowel looking glass further, if gastric bowel lens does not have a problem, that still needs to have vivid check of celiac lens peritonaeum further.
Liang Jiao is awarded and patient and family member communicate, because patient constitution is poor, go to already medical history of sequela of block having a head, no matter the risk that gastric bowel lens checks is in which hospital is existence, the possibility that bridge professor thinks he checks clear disease in hospital of center of the store that be stationed in a horse is very large, the proposal does not need to turn temporarily courtyard, if be not checked really,give a reason, turn again the courtyard is not late.
According to the diagnostic train of thought that Liang Baosong teachs, ask for so that the family member agrees, the following day, I did gastroscope to check with respect to close self-sufficient patient, receive gastric pitch when gastroscope, I observe extensive hyperplasia, canker, mucous membrane is inflexible, peristalsis disappears, touch ooze blood, the culprit of this ascites should be cancer undoubted, I took mucous membrane organization to make pathology inspection seriously to the patient. This not, final pathology result came out, it is cancer of the stomach! We turn the patient in time also to tumor division to be treated further.
Pass this personally the diagnostic course that experience Liang Baosong teachs, I understood bridge professor deeply to diagnose " cover a region " importance, it can make our train of thought clear, not allow examine of fallibility examine leakage, and, particularly simple and practical, everybody did from me this experience in sharing arrive?
