That should be considered another form of communication between a doctor and postoperative patient. Although Harry was just a dog that lost its golden l.u.s.ter due to old age, it was family in the eyes of Mr. Qin and his daughter.
Following Mr. Qin, they both walked out of the emergency building.
The building was as warm as Spring, but a chilling wind blew outside. Zheng Ren did not feel too cold. His physical fitness had improved significantly recently, which was obvious.
As soon as he walked out of the emergency building, the back door of a car parked in front of the gates opened. A yellow and white golden retriever jumped out of the car.
The dog was very old. The color of its fur was no longer pure. Yellow and white were mixed together.
It pounced directly at Zheng Ren. Zheng Ren was worried that it would fall off from all that vigorous wagging.
Harry panted heavily. It stuck out its tongue and rubbed its head against Zheng Ren's pants.
Mr. Qin was worried that Zheng Ren did not like dogs so he quickly pulled Harry away.
Zheng Ren waved his hand and gently stroked the dog's head.
A teenage girl jumped out of the car and stood beside Mr. Qin.
"This is the Doctor Zheng you've always wanted to see. He's the one who operated on Harry," Mr. Qin said.
The little girl then cheerfully came behind Harry and bowed deeply to Zheng Ren. "Doctor Zheng, thank you for operating on Harry."
Uh... this display of gratitude... Zheng Ren had encountered it before. However, it was only a surgery on a dog. Was there a need to express gratitude that way?
Perhaps.
He was at a loss.
"It's all thanks to you. My dad didn't tell me that Harry was sick. He only told me after the surgery was successful. What a meanie," the girl pouted.
Mr. Qin smiled. "Doctor Zheng, thank you very much."
"No problem," Zheng Ren said quickly.
With Harry's head coiled in his hand, Zheng Ren felt that the old dog with impure fur seemed to know that he was its savior, so it was especially kind to him.
Of course, it was also possible that the dog was very friendly with everyone and was generally nice to everyone.
It was very cold outside. After a few words, Mr. Qin was about to leave.
The little girl refused and insisted on taking a photo with Zheng Ren.
Zheng Ren agreed with a smile.
Mr. Qin took out his phone. Zheng Ren half-squatted beside Harry while the little girl stood on the other side, smiling innocently.
After the photo was taken, Mr. Qin brought the child and Harry to the car. Then, he quickly returned to the lobby of the emergency building with Zheng Ren. He added Zheng Ren's WeChat account, saying that he would find a better photo to send him later. After expressing his gratitude once more, he turned around and left.
Through the transparent door, Zheng Ren saw the little girl and Harry greeting him on the other side of the car window.
The little girl's reddish face had a sincere smile. Meanwhile, Harry's tongue licked the breath he left on the car window, as if trying to remember Zheng Ren's appearance in his mind.
Zheng Ren waved his hand and watched them leave. Only then did he turn around and walk toward the emergency ward.
Zheng Ren walked very slowly. The scarred face of the little patient with Lesch-Nyhan Syndrome and the innocent face of the little girl gradually mixed together and finally turned into nothingness.
When he walked to the emergency ward, Zheng Ren's emotions had already calmed down.
He sat silently in front of his desk and turned off the computer. After that, he picked up his Fundamentals of General Surgery and continued to read.
Although reading in the system library did increase his skill points faster than reading the book, the skill points would not be directly added to the general surgery skill tree.
Zheng Ren still remembered the epic experience of performing simultaneous pancreatoduodenectomy on the day the system descended on him.
Although it was almost impossible to beat, Zheng Ren was obsessed. He hoped that one day, he would be able to stand in front of the operating table with the best general surgery skills.
After reading for a while, Zheng Ren's phone rang again.
He picked it up and saw that it was Chief Xia from the Department of Digestive Medicine.
Chapter 593 - Complicated Gallbladder
"Hello, Chief Xia," Zheng Ren said as he answered the phone.
Ever since he helped a few patients for the Gastroenterology Department, Chief Xia clearly recognized Zheng Ren's abilities.
After that, whenever Chief Xia encountered a difficult problem, she habitually began to look for Zheng Ren to lend her a hand. Given her personality, it was very difficult for her to do so.
"Chief Zheng, I have a patient here. Can you help me take a look?" Chief Xia said.
Just as expected, but Zheng Ren did not mind. It was just to take a look. How much trouble could that be?
Moreover, as Zheng Ren's skill tree progressed, he also needed to see more patients and acc.u.mulate more clinical experience.
After bidding goodbye to Zhong Min, who was on duty in the emergency ward, Zheng Ren headed to the Gastroenterology Department.
An emergency consultation required him to be there within five minutes. However, for a private consultation like that, there was no time limit at all. It was a favor after all. Since Chief Xia was not in a hurry, there was no need for Zheng Ren to rush over.
When he arrived at the Gastroenterology Department, Zheng Ren glanced at the doctor's office. He did not see Chief Xia, so he went straight to the front door of the chief's office and knocked on it.
"Chief Zheng, you're here." Chief Xia was reading the scans on the computer. When she saw Zheng Ren enter, she stood up and greeted him.Find authorized novels in , faster updates, better experience, Please click #'s-studio_16489637605120805/complicated-gallbladder_51157144304676686 for visiting.
"Chief Xia, what's the matter?" Zheng Ren asked.
"There's this patient. I'm not sure about the diagnosis. I always feel that there's something wrong. Help me take a look." Chief Xia then pushed Zheng Ren to the desk and pointed at the CT scan of the upper abdomen on the screen, saying, "You're good at reading scans. What's this?"
Zheng Ren looked at the scans carefully. Chief Xia said, "The patient complained of intermittent right upper abdominal cramps and was hospitalized for seven months. The patient had an episode weekly, and each episode would hurt for one to three days. When the patient was in pain, there was no nausea, vomiting, fever, or jaundice. The most recent episode of abdominal pain was one month ago."
"Okay." Zheng Ren scrolled the mouse with his right hand. He looked at the scans frame by frame carefully as he asked.
"Before admission, there was an ultrasound." Chief Xia was very familiar with her work. She was also very attentive to this problematic patient. She did not even need to look at the list for supplementary examination. She said casually, "The abdominal ultrasound showed that there was a fold in the upper and middle part of the gallbladder. There were no gallbladder stones and the gallbladder wall was slightly swollen. There was no dilation of the bile duct inside and outside the liver. The diameter of the common bile duct was about 3 mm."
"Fold?" Zheng Ren muttered.
The gallbladder fold shown by the ultrasound was not a literal fold like an origami paper.
In clinical practice, gallbladder fold referred to the phenomenon of the gallbladder mucosa folding.
It was mostly seen in patients with chronic cholecystitis, but there were also some caused by congenital developmental abnormalities. If there were symptoms, it would be shown through the digestive system, for example, bloating.
Moreover, the patient's gallbladder wall was slightly rough, so it could be diagnosed as cholecystitis.
"After admission,
ceftriaxone was given as anti-inflammatory treatment. After ten days, the pain improved significantly but the upper abdominal CT showed stones." Chief Xia frowned, feeling a little puzzled.
The patient's symptoms had improved, so he should be able to leave the hospital.
Out of caution, Chief Xia checked his upper abdominal CT before the patient was discharged.
She did not expect the CT scan to show that the patient's condition had not improved, but worsened instead! The inflammation had improved slightly, but a stone had appeared in the gallbladder.
However, the patient's symptoms did not worsen. Instead, he was alive and well, clamoring to be discharged from the hospital.
It was not common for the patient's self-reported symptoms to go against the clinical examination. They had to be extra cautious every time.
Zheng Ren looked at the CT scan of the upper abdomen frame by frame and stopped asking Chief Xia about the patient's condition.
He had said what he needed to say. Nothing else was important.
Chief Xia noticed that Zheng Ren looked at the position where the gallbladder was folded for a few more seconds. Then, he continued going on to the other sections.
A few minutes later, Zheng Ren finished looking at the CT scan and said, "Chief Xia, the patient shouldn't be diagnosed with cholecystitis."
"Oh?" Chief Xia was stunned.
Overturn the original diagnosis? Was there a need to be so direct?
However, Chief Xia did not refute. She was ready to listen to Zheng Ren's explanation.
Nevertheless, Zheng Ren did not provide an explanation. Instead, he stood up, smiled and said, "Let's do an MRCP."
"Do we need to?" Chief Xia was puzzled.
"Let's go take a look at the patient. If my judgment is correct, this patient should be a rare double cholecystitis patient."
Chief Xia was speechless.
"CT scans can only be used for guesses. It will be obvious once we do an MRCP." Zheng Ren suddenly remembered something and asked, "Is the patient's family financial situation alright?"
"It's alright..." Chief Xia said.
"If the financial situation permits... forget it. We can also do a three-dimensional reconstruction while doing an MRCP. The patient doesn't have any symptoms now. It's better to do a more detailed examination so that we can decide how the surgery should be done," Zheng Ren said, "The MRCP may have artifacts. It is impossible to determine whether the two gallbladder tubes will merge into the common bile duct after fusion or independently.
"After diagnosis, we can decide the operation method for the patient according to the classification of the gallbladder malformation Harlaftis depending on the variant being type 1 or type 2."
Chief Xia was sweating.
The reason she looked for Zheng Ren was to determine why the patient's upper abdominal pain symptoms had eased, but the examination found gallbladder stones instead.
She did not expect Zheng Ren to directly pull out the double gallbladder malformation out of nowhere.
Chief Xia almost vomited blood.
However, when she saw Zheng Ren being so sure, she also had some doubts.
Nevertheless, the problem was the double gallbladder deformity... even if Chief Xia was an old clinical chief, she had never seen it before.
When Zheng Ren noticed that Chief Xia did not move and did not have any intention of visiting the patient with him, he felt a little strange. However, he immediately came to a realization.
"Chief Xia, gallbladder stones have nothing to do with the double gallbladder deformity," Zheng Ren said with a smile. "The patient's gallbladder does indeed have sand-like stones. If the ceftriaxone is stopped, it will be fine in three to five days."
"Huh?" Chief Xia was confused.
"After the application of ceftriaxone, reversible cholestasis occurs. The reason is that the calcium salt, the metabolite of ceftriaxone, enters the bile and easily settles in the gallbladder, acting as a "stone nucleus", inducing gallstone disease," Zheng Ren said, "If you don't believe me, you can look at the instructions of ceftriaxone. There are complications in this regard."
"Then... what exactly is wrong with this patient?" Department Chief Xia was confused.
"It's a double gallbladder deformity, which is more serious. The silt-like gallbladder stones caused by ceftriaxone can disappear after a period of time after the drug is stopped. It is also known as drug-induced gallbladder stones."
"Drug-induced gallstones?"
"For example, contraceptive pills, ceftriaxone, non-steroidal anti-inflammatory and analgesic drugs, intravenous high-nutrition drugs, and dipyridamole may all cause drug-induced gallstones," Zheng Ren said.
"How did you know?" Department Chief Xia pressed on.
"From the surgery department. We once diagnosed gallstones, but after the operation, there was nothing in the gallbladder. In some cases, they would just let it slide. Meanwhile, in some other cases where the family would not let the matter rest, it would be treated as a medical accident. That's why I have done more research in this area. "
Department Chief Xia knew that Zheng Ren's standard was not bad, but she did not expect his standard to be so high.
She picked up the phone and said, "Chief Zheng, please wait a moment, I'll ask Chief Wang from the MRI Department."
Chapter 594 - It Was Too Amazing
"Chief Wang, it's me, Old Xia. Yes, I have a patient who needs an emergency MRCP. I'll have to trouble you."
As she spoke, she covered her phone and asked, "Chief Zheng, are you saying that you want to do a three-dimensional MR reconstruction?"
"Yes, I did it on the way here. If you want to do a three-dimensional CT reconstruction, you have to relocate the patient. It's too troublesome," Zheng Ren said.
"Chief Wang, we still have to do a three-dimensional MR reconstruction. It hasn't been carried out? Oh, that's fine. I'll bring the patient over now. Sorry for the trouble."
After that, Chief Xia hung up the phone and said to Zheng Ren, "Chief Zheng, our hospital hasn't carried out a three-dimensional MR reconstruction. "
"Oh, they usually don't run a three-dimensional MR reconstruction, " Zheng Ren said. "The reconstructed section is thicker and the effect is not as good as a three-dimensional CT reconstruction. "
"Then..."
"It's okay. It's just to take a quick look. MR is sufficient. It saves the patient some money and it doesn't have to be that clear."
"I mean no one can do it."
"Chief Xia, I know no one can do it. I can do it myself." Zheng Ren finally understood where the misunderstanding between him and Chief Xia was. He smiled and said, "After you're done here, send a doctor to take the patient to do the MRCP. I'll follow him to take a look and do the reconstruction. It'll take twenty minutes tops."
Chief Xia looked at the young and energetic Zheng Ren and felt conflicted.
However, that was not the usual youthful vigor. His energy was brimming with confidence.
Ceftriaxone was commonly used in clinical medicine. Chief Xia had used it for decades, but she had never encountered anything like a silt-like stone.
She guessed that if what Zheng Ren said was true, then she might have encountered it. However, she did not do the relevant check-ups. The patients had no symptoms and recovered after being discharged from the hospital.
Regardless, that was a hidden danger. It was a hidden danger that she, a clinical chief who had been in the hospital for decades, had not noticed.
She was curious and anxiously waited for Zheng Ren to bring the patient for a check-up. After that, she immediately went to the pharmacy to find a nurse.
The nurse in charge of collecting medicine did not know why Chief Xia, who had always been strict, was looking for her. Looking at her anxious expression, she was a little nervous.
When she heard that Chief Xia wanted the instruction manual for ceftriaxone, she immediately heaved a sigh of relief.
The nurse quickly found a box of ceftriaxone, opened the packa
ge and took out the instruction manual inside.
After taking a look, the words were too small. She then went to the convenience store in front of the nurses' station and took a magnifying glass for Chief Xia.
Chief Xia picked up the instruction manual for ceftriaxone. After opening it, she found the part of drugs contraindications and side effects. She took the magnifying glass and looked at it carefully.
The more she looked at it, the more surprised she was.
It was written on it—gallbladder ultrasound could be misdiagnosed as the shadow of gallbladder stones. These would disappear with the end of the treatment or termination of the use of this drug.
A drug that had been used for more than ten years would actually have this kind of special drug reaction.
Chief Xia was stunned.
She vaguely remembered that when she was still a young doctor, when Rocephin(ceftriaxone), produced by Shanghai Luo Shi Pharmaceutical, had just entered clinical usage, it had won the favor of the clinicians because of its effectiveness and moderate price.
At that time, she had also studied the instruction manual. It seemed like… she was in a trance… she had an impression of it in her memory. She had read it before.
Chief Xia had become an experienced chief since she was a young doctor. She had never met a single case. She had never even heard of it from others. She had long forgotten about this one-in-a-million possibility.
Now that she was reminded by Zheng Ren and saw the instruction manual, Chief Xia was shocked and broke out in a cold sweat.
This young doctor was really transforming into a formidable existence! Chief Xia held the magnifying glass and stared at the line of words for a long time.
How did he remember such strange complications and side effects of the medicine? Moreover, he was able to confirm the patient's symptoms immediately after he heard herself mentioning it.
Amazing, truly amazing!
Chief Xia suddenly recalled a matter that had been widely spread in the hospital recently—it was said that a German professor had traveled thousands of miles to Sea City to learn surgery from Chief Zheng.
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