"Tanglou, have you really seen the cause of the patient's illness? Does the patient have appendicitis?"

Ma En followed and was curious. Anyway, he didn't see anything at all. He had rebound pain and tenderness in the lower abdomen, and there were shadows from color ultrasound to prove it. Based on his experience, this was not the most typical appendicitis, and he had to undergo a McLaren incision.

Wouldn't it be better to have an abdominal dissection?

Tanglou walked quickly: "It's appendicitis, but it's not appendicitis."

"ha?"

Ma En was completely confused.

After returning to the office, I checked the time and it was less than twenty minutes before the consultation.

"Tian Linsheng, help me set up the venue, prepare the projection, and pour the tea."

Ma En suppressed the confusion in his heart and decided to complete the preparations first.

Tanglou was studying the medical records on the sidelines. After all, he had to draw his own conclusions rationally during the consultation, so he was collecting evidence and formulating his own treatment plan.

After everything was ready, Qingping and Song Yang also came to the office.

Song Yang looked at the four prepared positions and was a little confused: "Dr. Qing, Director Cheng is also coming?"

"No, it will just be you and me, Ma En and Tang Lou in a moment."

Qingping sat in the host's seat and turned on the computer. Ma En had already prepared the information.

"Tanglou?"

Song Yang frowned. Naturally, he had heard of Tanglou's name. He was a doctor who came to a county-level hospital for general surgery not long ago. He was so young and came from a county-level hospital. Song Yang instinctively felt a little uncomfortable.

untie.

"In this consultation, even Ma En is just sitting in and putting forward some small ideas. There may be something wrong with the tenement building."

Song Yang said softly to Qingping, after all, they are both senior attending doctors. As a resident doctor with some qualifications, Ma En has some experience in appendicitis surgery, but Tanglou, it is a bit too outrageous.

"Tanglou still has some research on appendicitis. Of course, it's mainly just to participate and observe. Dr. Song, let's get started."

Qingping himself only had some minor questions about this case, and basically communicated with Song Yang. As for Tanglou and Ma En attending the meeting together, it was mainly to send a signal to the department that Tanglou was a young man he valued very much.

At the same time, it is also constantly establishing an impression for Ma En that Tang Lou can be on an equal footing with him, which will also help to promote Tang Lou to carry out laparoscopic appendicitis surgery later.

Of course, it would be best if Tanglou could come up with some valuable ideas and suggestions, but I didn’t expect much.

Song Yang nodded slightly, but he didn't care in his heart. After all, it was a fantasy for an attending doctor to believe that a small intern could put forward constructive opinions in department consultations.

In his medical team, even for the simplest appendicitis surgery cases, at least senior residents are qualified to attend the meeting. As for the interns, they are content to serve tea and water on the side.

"Then let's get started."

Qingping and Song Yang naturally sat close to the projection screen, one on each side.

Ma En looked at the signs, held a blank notebook and huddled in an empty space behind Qing Ping.

Song Yang, who was on the side, naturally saw it from the corner of his eye and smiled slightly, showing that he was doing so without concealing it.

Just when Song Yang was about to look at the projection screen, Tang Lou took a piece of information and sat down next to Qing Ping and in front of Ma En.

Moreover, there was a paragraph of handwriting neatly written on the notebook, and the whole person seemed to be eager to speak.

Song Yang picked up his cup and took a sip of tea, feeling a little confused.

Is this tenement building really prepared to put forward opinions?

In this kind of consultation between attending physicians, residents and interns are essentially just shouting "666" salted fish from the side, and always watching the cup of the dry-mouthed boss you mentioned, and hurrying up and behaving well before it is about to dry up.

Just continue.

"Dr. Song, in this case, the symptoms and the color ultrasound showed very clearly that it was the typical symptoms of appendicitis. But when I was doing the physical examination and pre-operative communication with the patient, I didn't know why, but I had a feeling that something was not quite right.

.But I can’t figure out the reason.”

Qingping said as he slid the picture onto the color Doppler ultrasound:

"Dr. Song, look, there is a finger-like echo with a diameter of 8.5 mm in the patient's right lower abdomen, and there is an echo-free dark band around it. We consider it to be an inflammatory appendicitis."

Then Qingping slid the picture to the chest X-ray and ECG: "The chest X-ray and ECG were normal. Combined with the physical examination, the patient had tenderness and rebound tenderness in the right lower abdomen, so the initial diagnosis was acute appendicitis. I formulated a surgical plan.

Make a Mai's incision and set a 5cm incision."

Song Yang looked at the information compiled by Ma En, and then looked at the color ultrasound and pictures on the projection.

"Since I haven't had a physical examination in person, based on the information currently available, I agree with Dr. Qing's preliminary diagnosis, which is also a very typical symptom of appendicitis. In fact, I am curious, why does Dr. Qing feel that something is not right?

"

As a senior surgeon, Song Yang has naturally experienced too many appendicitis surgeries: "The symptoms of patients so far are actually clear enough and specific. Compared with some inexplicable causes of acute abdomen or suspected acute appendicitis, they are much clearer.

.Furthermore, as an appendicitis operation, McLaren's incision and traditional laparotomy are the best options, even if there are some minor cases. Based on Dr. Qing's experience and response, and further investigation during the operation, I think it is the best solution."

Regarding Song Yang's judgment, Qingping naturally thought about it. If he was the surgeon, there would be no problem and there was no need to worry about it. However, he was preparing this surgery for Tanglou, so he needed to be more cautious in the early stage.

Qingping looked at Tanglou and thought for a while: "If we decide on Mai's incision, it is not impossible to wait for further exploration during the operation. However, I am not the surgeon of this operation, but I still hope that we can brainstorm before the operation. First of all, I will

Please explain why I feel something is not right. That is the path and time of occurrence of the metastatic pain reported by the patient, which is a bit strange."

Qingping stood up, and then recalled the location of the pain pointed by the patient and the path and time of pain transfer and change when he examined the patient.

After moving his fingers a few times, Qingping sat down and looked at Song Yang: "Is there something slightly wrong? But if the path described by the patient is followed, it is actually somewhat contradictory to the shadow of the right lower abdomen shown by color ultrasound.

But the color Doppler ultrasound and the final location of the pain are consistent."

Song Yang was rich in experience. Naturally, he also frowned when Qingping described the trajectory. According to this trajectory, it didn't look like an appendix disease. It seemed like something was slowly flowing from the upper abdomen to the lower abdomen, but it was obvious.

The appendix cannot move freely in the abdominal cavity like this.

The metastatic abdominal pain caused by appendicitis is not due to the movement of the appendix itself, but because the pain in the early stage of the onset is caused by the appendix's strong peristalsis in the wall of the tube in order to remove fecal stones or foreign bodies and relieve the obstruction of the lumen, which reflexively causes visceral nerve dysfunction.

Therefore, the visceral nerves cannot accurately identify the exact location of pain in the first place.

When the inflammation spreads to the appendix serosa and its mesangium, the peritoneum of the right lower abdominal wall innervated by the receptor nerves is stimulated, and the location of the pain is determined, thus giving rise to the illusion of classic pain transfer in appendicitis.

However, the scope of this kind of transferred pain will not be as long-distance "flowing" as described by the patients recalled by Qingping before.

Song Yang took a sip of tea, and Ma En stood up quickly and came over to refill the tea.

Song Yang touched his chin, suddenly thought of a possibility, and suddenly realized: "Dr. Qing, preoperative physical examination is naturally important, but don't ignore the deviations in the patient's description. After all, they are not professionals. Many times the patient's first

This statement is deviated from the facts. We still need to make a comprehensive diagnosis based on color ultrasound, rebound pain and our experience."

Qingping took a deep breath and looked at the color ultrasound and other information. What Song Yang said was indeed reasonable. In many cases, patients' self-reports can indeed mislead doctors.

"I recommend performing a McLaren incision in case there is a small problem, even an ectopic appendix. Our experience is enough to deal with it. Continuing to investigate will only delay the operation time. The patient's surgical indications are clear, Dr. Qing

Don’t hesitate.”

"And I suggest that this operation should not be performed by a lower-level doctor. Just in case, Dr. Qing will perform it himself."

Song Yang took a thoughtful look at Tanglou and made his conclusion.

Qingping nodded: "What Dr. Song said makes sense. Maybe I'm sensitive, so I'll decide on a Mai's incision. Ma En, do you have any other opinions?"

Song Yang was already ready to get up and leave. After all, Qingping said that Ma En and Tang Lou would give their opinions only because of the situation. After all, the two big bosses had made the final decision. How dare the resident doctor and the training doctor dare to raise objections? That would be too ignorant of the rules.

.

Sure enough, Ma En shook his head: "No objection, no objection. I agree with Dr. Song's point of view. If you perform McLaren's incision surgery, my judgment is also typical of acute appendicitis. There is no controversy."

"Tanglou?" Qingping naturally wanted to complete the procedure.

Song Yang had already stood up and was ready to leave.

"I think this patient should have a laparoscopic appendectomy!"
Chapter completed!