Section 203

"My chest doesn't hurt."

"Where is this place?" Zhang Yi pressed on the appendix again.

"No pain……"

"Having diarrhea?"

"No diarrhea...it just hurts here...it hurts so much that I can't stand it..."

At this time, looking at Zhang Yi's series of palpations, basically all the doctors present had a suspicion.

There is no pain anywhere else, only the stomach and pancreas.

That means it's either a gastric ulcer or pancreatitis.

Combined with the fact that the patient did not have diarrhea, blood in the stool, or gastrointestinal reactions, the result is closer to a pancreatic problem.

When they thought of this, Deng Wei and Xiao Zhiwen looked at each other.

Deng Wei: Go, apprentice!

We lost the game just now, and now a patient with similar symptoms of pancreatitis comes in. Are you not allowed to go up and demonstrate your clinical experience? ?

Go for it!

Take back our place!

Xiao Zhiwen instructed that he was indeed inferior to Zhang Yi in terms of operation.

But he himself has already passed the examination to become an attending physician.

The attending doctor's clinical experience is richer than that of the regular trainee, right? ?

Before Zhang Yi could speak, Xiao Zhiwen took the lead and asked:

"Did he eat anything greasy before he had abdominal pain yesterday? Or drank a lot of wine?"

Other migrant workers nodded quickly:

"That's right, the boss of our construction site had a treat the night before yesterday. We went out for a dinner. We ate hot pot and drank some wine.

But hot pot isn’t too greasy, right? It's just spicier. "

"Uncle, let me ask you a few questions." Xiao Zhiwen approached the patient again and asked.

The uncle on the flat car nodded: "Okay... okay."

"Does your stomach hurt often or did it just start yesterday?"

"Just...just yesterday..."

"Let a nurse take his temperature."

After Xiao Zhiwen finished speaking, he lowered his head and asked:

"Uncle, do you feel nauseous when you have a stomachache? Do you feel acid reflux in your stomach?"

"No...just a stomachache...no discomfort in my stomach."

Xiao Zhiwen basically ruled out stomach problems after asking this question.

Now the target is pancreatitis.

Xiao Zhiwen turned around and looked at Zhang Yida:

"I initially suspect pancreatitis. Let's check the B-ultrasound, abdominal CT, blood and urine amylase."

Zhang Yi nodded: "I know."

After finishing speaking, Zhang Yi did not rush to give medical advice. Instead, he held a stethoscope and listened to the migrant worker's lungs for a while.

Everyone was puzzled.

Now the results are obvious, it is probably pancreatitis.

If the amylase is checked and the infusion is controlled, the person will be fine.

Why else is he listening to the chest?

Qian Zhenggang only thought that Zhang Yi wanted to check more, so he didn't say anything.

After putting down the stethoscope, Zhang Yi said:

"The sound does not sound clear during lung auscultation. I recommend adding a lung CT scan."

Xiao Zhiwen became curious when he heard it. He took the stethoscope from Zhang Yi and listened.

Embarrassed...

Why can't he hear anything?

Isn't this a normal voiceless sound?

What's different?

At this time, the old man lying on the flat car quickly complained when he heard that more inspections were needed:

"Doctor...I...let me do less examinations. I don't have much money to begin with..."

But Zhang Yi shook his head and insisted:

"Uncle, I am doing this for your own good. A CT scan of the lungs must be done."

"But doctor...I don't have money...can you do it with the lungs when you do the abdominal surgery?"

"I'm afraid this won't work. Each part is separate."

"But... I'm fifty-eight this year, and at home... I still have an elder and a younger brother at home. I can save as much as I can, doctor...

You're fine, fine. Is it okay if I don't do this CT scan? "

The patient lying on the flat car was very weak, but he felt helpless when he thought about how much money it would cost to go to the hospital.

Zhang Yi frowned and looked at his lungs.

"No, you have to do a CT scan of the lungs! Three hundred yuan... I'll help you get it done. Take the blood first and then send it to the imaging department."

As soon as Zhang Yi said this, the doctors around him all looked at him in surprise.

He actually took the initiative to help the patient pay for the CT scan?

Should I call him stupid or kind?

Although Qian Zhenggang felt very relieved, he also felt that if this person really didn't have the money to do a lung CT, he wouldn't do it.

If it is found to be pancreatitis, there is no need to do a lung CT.

At this moment, Deng Wei also stood up and asked:

"Zhang Yi, why do you insist on letting him do a CT scan of his lungs?"

Zhang Yi explained: "The sound of lung auscultation was not right, just in case, so I did a CT scan to check."

Deng Wei frowned and listened carefully for a while with his stethoscope.

I didn't hear anything wrong.

He thought to himself, is Zhang Yi a little unnecessary?

The patient lying on the flat car heard that Zhang Yi was willing to pay, and he wanted to sit up and bow to Zhang Yi gratefully.

But Zhang Yi pinned him on the flat car:

"You don't need to thank me, just lie down first. Which of you is a family member, come to the office with me to sign first, and the others can send him for examination first."

Several migrant workers have no family members, but they have colleagues who are willing to help sign.

Half an hour later, all the patient's test results came out.

Blood amylase: 378u/l

Urinary amylase: 3974u/l

The blood and urine amylase were all higher than normal.

With such a high value, it is basically certain that it is pancreatitis.

In addition, the blood sugar level was not high, and the three blood lipids were normal.

This shows that pancreatitis is not caused by blood sugar and hyperlipidemia.

No bile duct and gallbladder stones were found on the B-ultrasound, indicating that it was not caused by gallbladder obstruction.

Finally, the CT scan.

The CT scan of the upper abdomen showed that the shadow of the pancreas was enlarged, which should be edema.

And there was free fluid around it.

It should be inflammatory exudate.

It seems that the old man's pancreatitis has developed into suppurative pancreatitis.

Finally, there is another CT scan of the lungs.

It doesn't matter if you don't look at it. Once you look at it, everyone's eyes are full of doubts!