After returning to the duty room, Tang Lou was thoughtful and began to think about how to deduce the patient's condition.

The rest of the symptoms can basically be inferred through previous examinations. It’s just the most important biliary roundworm symptoms that are really difficult to explain.

Common biliary ascariasis manifests as a sudden, piercing-like pain in the upper abdomen, but the patient's abdominal signs are often milder, so the patient's self-report cannot think of it at all.

And for ordinary abdominal color ultrasound, the diagnosis is basically confirmed when real-time ultrasound shows living and moving roundworms.

However, due to the long onset time of this patient, his self-reported symptoms and signs were atypical, and no roundworms were found in the biliary tract by color ultrasound from other hospitals or our hospital, it was impossible to consider roundworms in the biliary tract based on conventional thinking.

This is a very rare disease.

This patient had pathological relaxation of the sphincter of Oddi due to previous episodes of gallbladder inflammation, allowing roundworms to burrow into the biliary tract, and repeated upper abdominal pain caused gas accumulation in the intestines to cause interference.

Therefore, routine color ultrasound examination failed to detect it.

Tanglou also had a headache. He knew the answer but couldn't tell him. It was really uncomfortable.

After all, Western medicine is rigorous, unlike traditional Chinese medicine where you can get away with it by relying on metaphysics. The more skilled you are, the better you are as a master.

Tanglou looked through it carefully again, hoping to find evidence that could deduce biliary roundworms from the inspection data.

After all, this is not Hecheng City No. 1 Hospital. If it is in its own department, with Tanglou's current status, it can operate independently and directly perform treatment. But in other people's territory, especially Ma Shuya, there is also an attending physician.

In a responsible situation, if you can't give a reason, you won't be able to convince him.

He cannot convince others, and with his qualifications, it will only make him a laughing stock.

In particular, how could the attending physician of Zijingang Hospital, who is not a big shot in the industry, listen to the aimless speculation of a junior doctor from Hecheng City No. 1 Hospital?

Seeing Tanglou frantically starting to research information, Ma Shuya was a little surprised and a little admired at the same time.

Obviously he just borrowed his own lounge to rest for a night, but he was as attentive to this patient as his own patients.

It is enough to show that Dr. Tang is really a very responsible and pure doctor.

"No wonder you can achieve such achievements at such a young age."

Ma Shuya was also infected when she saw Tang Lou being so serious, and her previous anxiety was swept away. Tang Lou's innocent heart and serious and responsible spirit towards patients were not the best way to support her going forward.

power.

"Thank you for letting me know that there are so many doctors who, despite the pain, discomfort, and helplessness, still work hard on the front line and work tirelessly to bring hope to patients."

Ma Shuya said silently in his heart.

And at some point, Muzi also climbed out of bed. Although he couldn't do anything to help Dr. Tang and Dr. Ma, Muzi could still pour them water, pass on information, and stay awake with them.

"Dr. Ma, I can't help you right now, but I will definitely work hard to research and try to help you as soon as possible."

Seeing Tang Lou and Ma Yashu who had been studying medical records all night, Muzi also made a decision in his heart: Look, being a doctor is actually quite good.

...

...

Early the next morning.

Muzi had already fallen asleep at Mashua's request.

Ma Shuya studied it intensively, but still had no clue. Just as he was squeezing his eyebrows, Tanglou suddenly put down the information in his hand.

"Found it!"

There was a sudden sound, and Ma Shuya looked up directly at Tanglou. Although he had stayed up all night, Tanglou's face was full of energy at this moment.

"Doctor Tang, what did you find?"

"Dr. Ma, if nothing else happens, I think I have found the cause of the patient's illness."

"real?"

Ma Yashu clenched her fist excitedly.

"Um."

Tanglou directly sorted out the three physical examination indicators, and then copied down a set of data:

"You see that the patient's liver function, obstruction index, and jaundice index have increased to varying degrees after admission, and the blood routine shows a slight increase in eosinophils. I suspect that the patient's common bile duct may be obstructed by some unknown reason.

Stem? At the same time, looking at this color ultrasound, the patient's external bile duct is slightly dilated, and the lower end of the common bile duct is a linear low-signal shadow. Is it possible that it is a parasite?"

Tanglou peeled off the most hidden symptoms and pieced together a bold inference through several sets of data.

"Status quo low signal shadow, status quo? Parasite?"

A picture also flashed through Ma Yashu's mind, and she said with some surprise: "Are you saying that the patient may have roundworms in the biliary tract?"

"Yes, it's very possible."

Tanglou didn't dare to talk enough.

Looking at the Tanglou, Ma Shuya calmed down for a full minute, and then carefully read the three inspection data and several easily overlooked data transcribed by the Tanglou.

"If it's really biliary roundworm, that's crazy!"

How can anyone analyze symptoms like Tanglou, and be able to find just a few from dozens of pages of information? There is no connection between them, and they are not critical data in their respective pages.

However, based on Tanglou's inference, it is indeed possible to look at the patient's physical indicators in reverse.

However, the attentive Ma Yashu soon raised his doubts: "But that's not right. If it's biliary roundworm, we should have discovered it during the first color ultrasound examination."

Ma Yashu looked at it again and recalled the first diagnosis made by Dr. Pan. At that time, it was because of the color ultrasound that he directly ruled out biliary roundworms.

"I don't know the specific reason. It may be that the patient's repeated cholecystitis attacks lead to physiological or pathological relaxation of the Oddi sphincter, allowing the roundworms to burrow into the biliary tract, and the repeated pain in the upper abdomen causes interference from intestinal gas accumulation. Therefore, color ultrasound cannot see it.

It’s also possible.”

Tanglou made a hahaha.

Ma Yashu looked at Tang Lou's face, a little confused.

Sensing Ma Shuya's suspicious gaze, Tang Lou laughed: "After all, I am extremely talented and have a lot of money. Diagnosis sometimes requires a flash of inspiration!"

"Do an MRI+MRCP and you should have the results."

Tanglou did not explain any more and directly gave Ma Shuya a testing plan.

"Can."

Ma Shuya nodded, feeling very curious in his heart as to whether it was possible that it was really what Tanglou said.

"Also, I recommend another proctogram."

Tanglou made another suggestion.

"Proctogram?"

Being able to become a resident doctor at Zijingang Hospital, Ma Shuya is naturally very capable and quickly reacted: "You suspect that the Chinese medicine enema may have caused secondary damage to the rectum during the first treatment."

"clever."

Tanglou stood up and looked at the time: "I'll leave the rest to you. I still have an operation to do, so I'll leave first."

"If you are diagnosed, please notify me as soon as possible."
Chapter completed!