Section 43

In the afternoon, a doctor in the emergency department suddenly asked for leave.

There was a shortage of people, and no doctor was available.

Li Yan thought about it and asked Zhang Yi to go again.

He had heard about the patient with cholangitis.

He was also shocked by Zhang Yi's analytical and observation skills again.

Although Zhang Yi did not have a certificate, his strong ability was much more reliable than Chen Fang.

Following Zhang Yi, Chen Fang sighed silently...

Woo, the worst attending doctor in history is here!

In the clinic, Zhang Yi sat in front of the computer.

And Chen Fang sat next to Zhang Yi.

Start calling numbers.

The first patient came in, also holding his stomach, probably abdominal pain.

"Doctor... I have a stomachache..."

Abdominal pain, cold sweat. Chen Fang glanced at Zhang Yi and directed the patient to lie on the bed next to him and began to check.

"Does it hurt here?"

"Not bad."

"Here?"

"Ouch... It hurts... It hurts so much!"

The patient was a middle-aged man in his forties.

Zhang Yi found that his entire pancreas was obviously edematous.

It should be edema pancreatitis.

After Chen Fang helped the patient to sit, Zhang Yi continued to ask:

"How long has the pain lasted?"

"It started in the morning, early in the morning... I still want to vomit... It's so uncomfortable."

"What did you eat yesterday?"

"I ate... I ate hot pot, and then I had some barbecue and drank some wine with friends in the evening..."

Zhang Yi took out a mercury thermometer from the drawer: "Put it under the armpit to measure the temperature."

"Okay..." The patient did as he was told.

"Do you usually drink a lot?"

The patient nodded: "Quite a lot, I like to drink a few sips when I have nothing to do..."

Zhang Yi shook his head, another disease caused by drinking.

Ethanol stimulates gastric acid secretion, secretion of secretin and cholecystokinin, and increases pancreatic exocrine secretion.

After entering the duodenum, it will also stimulate spasm of the sphincter of Oddi and edema of the duodenal papillary muscles. Once edema occurs, pancreatic juice cannot be discharged and the pressure in the pancreatic duct will increase.

In addition, if the patient is a long-term drinker, the protein content in the pancreatic juice increases, forming protein plugs, and the pancreatic juice cannot be discharged.

So after this series of reactions, the pancreas naturally develops edema and inflammation.

Pancreas: Humph~ You drink and make me feel uncomfortable, so I will go on strike to make you uncomfortable~

Five minutes later, the mercury thermometer showed 38.3℃.

Chen Fang looked at Zhang Yi again and asked cautiously: "I feel that this time... it should be pancreatitis, right?"

Zhang Yi nodded while opening the examination form: "Well, the symptoms are very similar. Take an X-ray to see if there are stones, and then check the blood amylase and urine amylase to get the results."

Chen Fang breathed a sigh of relief without leaving any trace.

Huh~

I didn't make a wrong diagnosis this time!

The patient covered his stomach and looked at them with complicated eyes.

It's so strange.

Why does the attending doctor on the right have to ask the intern doctor next to him for his opinion before making a diagnosis?

Did they wear their work badges upside down?

Otherwise, why does this attending doctor act like a little brother?

Edema pancreatitis is also called mild pancreatitis, which is easy to check and treat.

Basically, the symptoms are abdominal pain, gastrointestinal reaction and low fever.

Then check the amylase. If it rises, it means pancreatitis.

The patient came back half an hour later.

There is no problem with liver and kidney function.

CT showed no stones in the gallbladder and bile duct.

There is a problem with amylase.

Blood amylase: 820u/l (30-110u/l).

Urine amylase: 384u/l (80-300u/l).

Blood amylase and urine amylase are used to diagnose whether it is pancreatitis and to distinguish between mild pancreatitis and severe pancreatitis.

Severe pancreatitis is also called obstructive necrotizing pancreatitis.

In this type of pancreatitis, urine amylase will decrease instead of increase.

"Doctor, do I have pancreatitis?" the patient asked, holding his stomach.

"Yes, but it's not serious, but you still need to get an IV for three or four days to get better. I'll prescribe medicine for you first, and you can go to the infusion room next door to find the nurse."

"Remember, don't drink or overeat, your pancreas is blocked because you drink too much and the secretion of the pancreas can't go out."

"If you don't pay attention, it will develop into chronic pancreatitis, or more seriously, obstructive necrotizing pancreatitis, which may be fatal."

"So remember, don't drink anymore."

"Got it... Thank you, doctor..."

Zhang Yi typed on the keyboard while talking.

Swish, swish, swish.

Give the doctor's advice.

The patient took the list and hurried to the next room for infusion.

The first patient was done.

The second patient came in.

It was a couple in their sixties.

The two walked in, supporting each other.

Old people.

It's common for the body's functions to degenerate and get sick occasionally.

However, this old lady's disease is not an ordinary one.

Zhang Yi's eyes darkened when he saw her.

This old lady... seems to have cancer.

Chen Fang saw that they were elderly people and took the initiative to move a chair for the two of them.

"Who of you is here to see a doctor?" Chen Fang asked.

The old man pointed to the old lady who sat down first and said, "Look, she always says that her stomach is uncomfortable."

Chen Fang stood up, put on a glove, and began to gently press the old lady's abdomen.

After the examination, Chen Fang said, "The tenderness point is not in the gastrointestinal area, it should be a problem with the uterus and appendages."

Zhang Yi nodded and ordered the examination.

Transvaginal color Doppler ultrasound, CT, notify the gynecologist to come for colposcopy.

First do a preliminary screening, and then do a cervical smear after confirming that there is a problem.

Although Zhang Yi can be completely sure that this old lady must have cervical cancer in his sight.

However, other doctors still need to conduct auxiliary examinations to know.

After a while, the gynecologist came down.

The person who came was Huang Meiying.