Chapter 2132 The Image Is Contrary to Logic, How to Judge? (Leader's Destiny, Destiny, Destiny, Self-Fate Plus 4)

Looking at the front film, the diagnosis of the patient is very clear, it is primary liver cancer.

There was a 3×4cm lesion on the liver, but the gallbladder was intact, not to mention stones, and the gallbladder wall was not even rough.

And what Zhao Wenhua inserted was not one front piece, but two.

The first one is the preoperative film, there is no iodized oil in the lesion. The second picture is after embolization, and the date should be the operation done a few days ago.

In recent films, the inside of the tumor has been necrotic, and the image of the needle tract can still be seen. It should be that radiofrequency ablation was performed after embolization.

"It shouldn't be gallstones." Zheng Ren said with certainty.

After watching the film, he knew where Zhao Wenhua was struggling.

Zhao Wenhua nodded again and again, "Boss Zheng, there was no gallbladder stone before the operation. It is only a few days ago, and it is impossible for a large number of sand-like gallstones to appear. This is a conventional logical judgment, but it happens to be present in imaging studies."

As he spoke, he sighed helplessly.

Sometimes there will be errors in imaging and logical judgments, and most doctors will use objective imaging judgments as the final basis.

After all, images exist objectively, otherwise, what is the point of performing image examinations on patients. In many cases, the logic of thinking is limited by the quality and level of doctors themselves. Even, it has something to do with the environment, emotions and other factors.

But at Zhao Wenhua's level, objective images can only be used as one of the reference standards, and he will not believe in any objective images.

The higher the doctor's level, the more issues to consider.

Every logically unsolvable problem may, in rare cases, lead to further deterioration of the patient's condition and even cause the patient's death.

Even if there is a typical imaging diagnosis on the film, you have to think about it.

This is why Zhao Wenhua stared blankly at the CT film with a "clear" diagnosis.

Because he could only feel that something was wrong, but he couldn't overturn the diagnosis of gallbladder stones. The two contradict each other, making it impossible to do anything.

"What about other laboratory tests?" Zheng Ren said.

Lin Yuan sat on the side, writing medical records. She was a little sleepy, but after listening to Boss Zheng's words, she became more energetic.

This is the tone of the superior doctor's words. As the bottom doctor in Boss Zheng's medical team, he must run over and hand over the other laboratory tests he needs.

It was the same at Harvard, and it was the same when I went back to 912.

However, Lin Yuan was stunned in the next second.

She saw Zhao Wenhua, one of the professors of the 912 Intervention Department, hunched slightly, ran to the computer, and quickly printed out all the patient's examination reports.

The printer hummed and spit out A4 papers one by one.

Lin Yuan looked at Zhao Wenhua in surprise, seeing his anxious face, every time the printer spit out a report, he had to take it directly into his hand.

As for what!

Although Boss Zheng is usually reluctant to joke, and it hurts to hit the radial styloid process with hemostatic forceps on the operating table, he is usually very kind.

Lin Yuan didn't understand why Professor Zhao Wenhua showed such a humble attitude. It's just... more like a little doctor than myself.

"Boss Zheng, take a look." Zhao Wenhua immediately took the problematic test sheet in his hand and blew air to lower the temperature of the printer on the A4 paper.

Sure enough, the patient had high white blood cells, high blood and urine amylase, and elevated serum lipase.

Decreased blood calcium, elevated blood sugar...

Zhao Wenhua has rich experience and has done all the inspections that should be done, and Zheng Ren has nothing to be picky about.

"Does the patient have a history of diabetes?" Zheng Ren asked.

"No." Zhao Wenhua replied immediately.

Without a history of diabetes, blood sugar is elevated, but blood calcium is low. This is one of the typical clinical tests of acute pancreatitis.

Is it postoperative stress response that leads to cholecystitis and acute pancreatitis? Zheng Ren flipped through the test sheet, thinking to himself.

Even though he thought so, he didn't draw a simple and rough conclusion.

The patient's test sheet and imaging examination point to clear - acute gallbladder stones, acute pancreatitis.

But!

There is still no way to explain how so many sediment-like stones come from.

If it was the kind of cholecystitis with a rough gallbladder wall, Zheng Ren probably gave up thinking about it at this time. However, the gallbladder grew from scratch, and a large number of sand-like stones appeared within a few days. No matter how I thought about it, something was wrong.

Moreover, it is a postoperative patient. Even if the diet is irregular, the family members take good care of it at this time, and they can eat as soon as they can.

eccentric.

Zhao Wenhua looked at Zheng Ren with great anticipation in his heart.

"Tell me about the patient's condition." Zheng Ren stood at the position where he was reading the film, with his arms resting on his cheek, and he looked at the film seriously, and said calmly.

The little doctor in Zhao Wenhua's group was about to speak when he was interrupted by Zhao Wenhua.

"That's right, Boss Zheng." Like a junior doctor, Zhao Wenhua began to report the medical history.

"The patient came to our hospital one week ago and was initially diagnosed with liver cancer. I went out and admitted the patient. Three days ago, he underwent interventional embolization therapy + radiofrequency ablation for liver cancer. There is a film left after the interventional embolization. images."

Zheng Ren nodded, indicating that he knew.

"The patient recovered fairly well after the operation. This morning, he suddenly complained of severe abdominal pain. An urgent CT scan revealed gallbladder stones and pancreatitis. Please consult with the hepatobiliary surgery. The same is true for the diagnosis of hepatobiliary surgery. Symptomatic treatment is recommended."

"But I watched the film and thought there was something wrong." Zhao Wenhua was very cautious. "The patient is not in a good condition now, and the pain has not been relieved."

"Have you been given painkillers?"

"I held back and didn't give in. There are some things I haven't figured out yet."

Zheng Ren nodded.

Give analgesics if you don't understand, that's death.

wrong! Just looking at the test sheet, it seems that there is something wrong, I just passed it by and didn't pay much attention.

Zheng Ren picked up the test sheet again in doubt, and looked at it one by one.

Soon, he discovered the problem. The patient's blood routine white blood cells were high, which can be used as one of the auxiliary diagnostic evidences for cholecystitis and acute pancreatitis.

However, the patient's hemoglobin has dropped to 76g/L, while the preoperative hemoglobin is normal.

"Anemia? Professor Zhao, how do you think about it?" Zheng Ren asked.

Zhao Wenhua shook his head in a daze.

Neither radiofrequency ablation nor interventional embolization will cause anemia.

Not to mention interventional embolization, a needle hole is placed on the femoral artery of the thigh, and then a guide wire and catheter are inserted to perform embolization treatment inside the blood vessel. Bleeding complications are rare because embolization itself is one of the hemostatic treatments.

In the case of radiofrequency ablation, the radiofrequency needle is not thick and penetrates into the liver. When it is withdrawn after ablation, the radiofrequency needle must be heated to avoid the transfer of the needle track.

While killing tumor cells, the punctured needle track will also be "hot" again. Even if there is capillary bleeding, it will be like being burned by electricity, and the bleeding will stop.

There was no anemia before the operation, and there was no anemia in the first follow-up after the operation. Progressive anemia only appeared in the early morning of this morning.

This is a particularly suspicious point.

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