The radiographic films were not clear, making it rather difficult to see it. The city-level hospital where the patient had initially gone to did not give the correct diagnosis.
Was he just making a stab in the dark?
"Continue," Chief Luo said softly as he felt that things were becoming more and more interesting.
"There's no problem with Chief Luo's diagnosis. Let me add a few more words." Zheng Ren stared at the radiographic films and said, "Did the patient suffer from Crohn's disease before?"
The patient's family members looked at each other and shook their heads.
One of them looked at Zheng Ren with some annoyance. It seemed that if he was not currently in Chief Luo's office, he would definitely point at Zheng Ren and scold him.
He even made a mistake in the diagnosis. How could he act so high and mighty?!
Zheng Ren caught a glimpse of the patient's family members' expression and immediately knew what was going on.
"Oh, Crohn's disease is also known as enteritis. In previous surgical books, it was called Crohn's disease. I'm used to that term. Did you take mesalazine orally for a period of time for treatment and then stop?" Zheng Ren said, not thinking much about it.
When he heard the term 'mesalazine', the patient's family was stunned.
"How did you know the patient was taking mesalazine orally?" Chief Luo asked, suddenly feeling that this bruised and swollen junior doctor was quite interesting.
"There are traces left behind after the ulcer healed." Zheng Ren looked at this difficult radiographic films and switched to a two-line mode. While still deep in thought, he answered, "After taking prednisone and mesalazine orally, the Crohn's disease was controlled but there would be a relapse after the medication was stopped."
Chief Luo looked at Zheng Ren curiously. This young man's standard of reading radiographic films was indeed not bad. There were indeed traces of the ulcers of Crohn's disease that formed after they healed on the radiographic films, but it was especially atypical. One had to have a high standard of reading radiographic films to notice this.
"Why oral administration of Prednisone?" Chief Luo asked the question.
"A part of the femoral head can be seen on the pelvic CT. there are already signs of early ischemic necrosis. Cross-referencing with the other conditions, the patient is considered to be suffering from Crohn's disease caused by long-term oral hormone treatment. Generally, when combined with mesalazine, it is prednisone," Zheng Ren said with assurance. He was firm with his answer.
Chief Luo nodded and said, "Continue."
"The image given by this radiographic films is considered to be a non-polyposis colorectal tumor. Unlike polyposis colorectal tumors, this type usually does not protrude into the intestinal cavity. Its shape is flat or slightly elevated. The shape of the blood vessels is indistinct. Uneven red spots and irregular nodules can be observed."
This sentence directly pointed to the problem. Chief Luo immediately made another change in his understanding of Zheng Ren.
Under normal circ.u.mstances, other than doctors who were very professional in looking at radiographic films, very few people could determine the indistinct shape of the blood vessels, uneven red spots, and irregular nodules from a single radiographic film.
In other words, abdominal CT usually only looked at the solid organs. Most of the time, when it came to looking at the intestines, it was through the gastrointestinal colonoscope.
The local doctor performed a plain CT scan on the patient's abdomen. He probably wanted to see if there was a tumor. After a rough scan, he did not see a large tumor, so he skipped it.
He just did not expect that Chief Luo and Zheng Ren would be able to see through such a simple radiographic film while at the Imperial Capital Hospital.
Chief Luo was also very curious. It was only natural that he could see through it. This was the Imperial Capital Hospital. It was one of the most powerful Class Three Grade A Hospitals in the country. It would be strange if he could not see through it.
However, this little fellow with a bruised face could also see it. He even gave a reasonable analysis. It was not a blind guess. There was a reason for that.
"How do you think we should deal with it?" Chief Luo asked. The speed at which his fingers hit the back of his hand increased by a few degrees.
"There are three solutions. One is to preserve more of the intestinal tract. After the surgery, we need to perform a colonoscope periodically to check if there are any new tumors growing in the colon. The second solution is to perform a rectal fistula, but it will affect the patient's quality of life. I would recommend the third solution, which is total colectomy and ileum-rectal anastomosis. In that case, we only need to check the rectum regularly after the surgery."
From the perspective of a general surgeon, Zheng Ren gave the patient's family three options and gave them the best solution he could think of.
There were a few words that Zheng Ren said that were relatively simple. The patient's family could not understand him, but Chief Luo knew what Zheng Ren was talking about—surgical resection of the diseased intestine and follow-up observation after the surgery.
He pondered for a moment and said, "The third option can be considered, but it's still safer to do a colonoscopy for pathology first."
Chapter 752 - Are You Zheng Ren?
"Yes, the lesion is relatively large and deep. It's very difficult to perform an endoscopic mucosal dissection." Zheng Ren pondered for a solution. "Let's first use an endoscope to take the pathology and then seize the time to perform the surgery."
After he finished speaking, he glanced at the patient's family.
He suddenly realized that he seemed to be speaking a little too much. He was in Chief Luo's office.
Chief Luo looked at Zheng Ren with interest. He felt that this young man was particularly interesting.
He had some ability but talked too much. He was probably anxious to show off.
Could it be that he did not go through the normal procedures to continue his studies, but that he used his connections to work here for a few months before he would need to leave again?
The patient's family left gratefully. Chief Luo asked the next patient's family to wait. He looked at Chief Resident Shen with a smile and waited for him to speak.
"Chief Luo, this is Boss Zheng. He's just been transferred to our hospital," Chief Resident Shen explained in a low voice.
Things had already exceeded his expectations. This was not a conventional way of visiting Chief Luo and greeting him.
Boss Zheng directly discussed the patient's condition with Chief Luo. Chief Resident Shen was not sure what would happen.
"Boss Zheng?" Chief Luo muttered these three words softly. He thought to himself, 'Is this really a colleague and not some rich businessman's son?'
However, had he receive a provincial-level scientific research fund or a national-level scientific research fund?
"Chief Luo, I just came to the Imperial Capital Hospital to be in charge of the research of the new TIPS surgical technique. Also..." Zheng Ren tried his best to keep a smile on his face, enduring the pain that came from the corners of his eyes.
Before he could finish his words, Chief Luo's expression suddenly changed.
"You're Zheng...Ren?" Chief Luo stared at Zheng Ren and asked.
"Yes, I'm Zheng Ren. I'll have to trouble you in the future," Zheng Ren said politely.
"Is it true that you were recommended as a candidate for the Nobel Prize?" Chief Luo asked. His tone was no longer as calm as before. He sounded a little anxious.
"Yes." Zheng Ren nodded.
Due to some coincidences, when Zheng Ren was recommended by Dr. Mehar and was nominated for the Nobel Prize, he was on a mission in the South. He had not gotten many details about him.
Department Chief Kong did not say anything in detail, but the nomination for the Nobel Prize did not involve confidentiality. Therefore, he would occasionally show off to his colleagues while he was eating
and drinking.
He had dug up the Nobel Prize candidate to the Imperial Capital Hospital. Wasn't that amazing enough?
This fact had only spread to a small portion of people. Everyone did not believe it, but they did not expect to see the main player today.
Chief Luo was stunned.
What Old Kong said was actually true!
It would be nonsense to say that there were no doubts. But today, this junior doctor with a bruised and swollen face appeared in front of him and gave the same diagnosis as him in the face of a relatively difficult 'ordinary' case. This meant that there were some problems with the original diagnosis.
The last three surgical methods that Zheng Ren proposed were also very reasonable.
Chief Luo also had these three surgical methods in mind and was very inclined to the third one. The two of them could be said to have the same idea when it came to diagnosis and treatment.
After all, the patient had a medical history of Crohn's disease. If the colon was not removed, there was a high probability that the disease would still occur in the future. Preserving the rectum was to improve the patient's quality of life after surgery. It was worth taking a little risk.
If the patient were to go through a colostomy, he would need to bring a bag with him everywhere to use for his excrement. The physiological structure of the patient would change from that of a normal person. It would cause huge psychological pressure and become a mental burden on the patient.
In some extreme cases, it might even lead to the patient's prem.a.t.u.r.e death.
The choice of the plan was directly related to the doctor's personality and diagnostic level.
It seemed that this young man's standard was really not bad.
Chief Luo stood up and extended his hand. He smiled gently and said, "Boss Zheng, nice to meet you."
Zheng Ren quickly extended his hand and shook Chief Luo's hand.
He was now finally on track with introducing himself, even if it was still a little too formal. Chief Luo gave him respect as an equal, out of respect for the Nobel Prize.
"Sit, sit, don't be so polite. Is it because the bed that Old Kong gave you is not enough, or is it difficult to take in patients?" Chief Luo said a few simple and polite words before going straight to the point.
As a doctor from the upstream department, what else could there be for him if a doctor from the interventional department came to find him?
"Both." Zheng Ren smiled politely and sat on the chair. He said, "Department Chief Kong is not at home and I don't know how to carry out my work. As such, I came to pay you a visit first."
"You're too kind, Chief Zheng. How's the progress on the TIPS surgery?" Chief Luo was more interested in this.
Zheng Ren was about to answer when a light knock sounded against Chief Luo's door.
Chief Luo shook his head and smiled. "It's like this in the hospital. I don't even have time to chat."
"I don't even have time to do most things. Please, go ahead." Zheng Ren smiled.
"Please come in," Chief Luo said as he sat up straight.
A man pushed open the door with an apologetic smile on his face. He wanted to come in. However, there were other family members of the patients in front of him.
"Chief Luo, I was introduced by Doctor Ding."
Chief Luo noticed the slight panic and said, "Wait for me outside. I'll have some other matters to settle first."
As he spoke, he waved at the people in line outside.
This way of handling things was very appropriate. One look and one could tell that Chief Luo faced these matters every day. He had already formed a pattern on how to solve these things.
It was all because of connections. It was better to line up.
Zheng Ren was not in a hurry. Anyway, he had nothing to do when he went back. The most important thing was to straighten out his relationsh.i.p.s within the hospital. Chief Luo's attitude was unexpectedly good, which made Zheng Ren feel at ease.
A middle-aged woman squeezed in and bowed first. Then, she whispered, "Hello, Chief Luo."
"Give me the radiographic films and tell me about the situation," Chief Luo was still very gentle. He did not say too much and was quite direct.
The woman put the radiographic films and other information on Chief Luo's desk. Her waist was still slightly bent and she maintained a respectful attitude as she said, "It's my daughter who has some problems. She's 22 years old this year. Recently, she's been feeling very tired. There are also a few times when she has abdominal pain. Her face is pale when she's in pain. It makes her look very scary.
"Every time she has an illness, she's sent to our local hospital. At first, she was diagnosed with intestinal obstruction but after careful examination, she was denied bedrest. The standard of the doctors in this small place is really low."
Chief Luo listened as he flipped through the patient's test results.
Zheng Ren sat upright on the chair. He was a little tempted but he forced himself to hold it in. This was the Imperial Capital Hospital, and he was in Chief Luo's office within the gastrointestinal department. He could not overstep his authority and do anything else. Otherwise, he would really lose his cool.
Chief Luo caught a glimpse of Zheng Ren's eager look from the corner of his eye. He found it funny, so he flipped through the test results and said, "Boss Zheng, can you take a look?"
Chapter 753 - What In The World Was Mitochondria?
"Uh..."
"This is the test report. I don't see anything abnormal at the moment." Chief Luo was not joking. Instead, he directly handed the test report that he had seen to Zheng Ren.
Zheng Ren saw that Chief Luo was magnanimous, so he smiled and took the test report to look at it.
The numbers of the test report were normal, so he did not see anything unusual.
Zheng Ren began to think about the patient's symptoms described by the patient's family—weakness in the whole body? What was he considering? Was it the fatigue and weakness brought about by a tumor, an electrolyte disorder, or some other illness?
There was also the diagnosis of intestinal obstruction, but a detailed examination ruled out the diagnosis.
Was it a fake intestinal obstruction, or was there a problem with the diagnosis from the local hospital? Zheng Ren quickly realized that treating patients in the Imperial Capital was indeed different from Sea City.
In Sea City, the patient's family would not trust the local doctor very much. As long as it was some difficult and complicated illness, the possibility of staying behind to treat it was not high.
However, when they arrived at the Imperial Capital, the patient's family members would usually bring the radiographic films and examination reports over first. They would not be able to see the patients themselves. Moreover, the patient's family members were filled with anticipation, as if they would be able to understand whatever the disease was while in the Imperial Capital.
Faced with this kind of anticipation, Zheng Ren felt extremely pressured.
In Sea City, he could advise the patients and their family members to go to a higher-level hospital. But now, he was standing in a higher-level hospital. This was almost the last stop for all kinds of difficult and complicated diseases.
Zheng Ren flipped through the test results while feeling the new environment and problems.
Chief Luo looked very carefully. He did not make a conclusion just because there were many people waiting outside.
He asked some detailed questions from time to time. It seemed very casual, but Zheng Ren could tell Chief Luo's real intention.
It was not a problem of diet, nor was it a problem of ionic disorder. Intestinal obstruction could temporarily be judged as a pseudo-intestinal obstruction.
Pseudo-intestinal obstruction was caused by nerve inhibition, toxin stimulation, or pathological changes in the smooth muscle of the intestinal wall itself, resulting in a disorder of the motor function of the intestinal wall muscles.
The patient had the symptom
s and signs of intestinal obstruction, but there were no mechanical intestinal obstruction factors inside and outside the intestine. Therefore, it was also known as dynamic intestinal obstruction. It was a kind of syndrome without intestinal obstruction.
Simply put, it was a problem with the intestinal peristalsis.
There was no particularly good way to deal with this type of intestinal obstruction. One only needed to pay attention to their diet.
It should be like this, but they could not easily give a diagnosis. Zheng Ren quietly took over the various information that Chief Luo had read.
Suddenly, a test report appeared in Zheng Ren's field of vision.
The bottom of the report for the electromyogram read as such—there was no abnormality in the electromyogram.
Were there no abnormalities?
Zheng Ren had never seen an electromyography before. It was a type of examination in the medical kinematics field. It was basically required by the neurosurgery department, the orthopedics department, and the trauma department. Even for them, they did not do much on the electromyography.
However, in Nanchuan Town, as well as the surgeries and diagnoses that followed through day and night, Zheng Ren's auxiliary examinations were improved.
An electromyogram list caught his attention. In the electromyogram, Zheng Ren read countless pieces of information.
In the System space, he did not notice how the skill tree branch of the electromyogram was. But at this moment, it seemed most likely that it had improved along with the improvement of CT, MR, and other skills.
There was a problem with the electromyogram! The diagnosis given by the local hospital was wrong.
"Chief Luo, take a look at the electromyography," Zheng Ren said softly.
"Huh?" Chief Luo was stunned. He did not understand electromyography. After all, he was a doctor in the gastrointestinal department and never looked at electromyography.
Chief Luo took a look at the report and was a little puzzled. "Boss Zheng, what do you think?"
"The local diagnosis was wrong," Zheng Ren said.
The Surgeon's Studio c1-799 Page 356
