Doctor of Healing

Chapter 233 On the one hand, he must treat diseases and save lives, and on the other hand, he also needs to perform performance appraisals (leader sueyee12 plus more × 5)

Ji Xiang chatted speculatively with Dr. Meng, and went to the emergency department for a walk every four days. At night, he accompanied Meng Qingfei on duty, helping to sew wounds and see patients.

Time flies, half a month has passed.

"Xiaoji!" Director Liu walked out of the office and shouted loudly at the door.

"Here, Director." Ji Xiang opened the door with his elbow while wearing disposable gloves, and came out from the pharmacy changing room, "What instructions to the Director."

"Hurry up and change the medicine, let's go to the consultation."

"Okay." Ji Xiang responded, turned around and quickly explained the precautions to the circumcision patient who had surgery on the weekend.

The circumcision he performed was quite good, with almost no postoperative complications, and he explained it in detail, and the patient felt less fear.

"Okay, just come to me for a dressing change after three days." Ji Xiang took off his gloves and said to the patient.

"Doctor, go to the outpatient clinic or come here?"

"It's fine to come here, and you have to register to go to the outpatient clinic. It's not worth changing the medicine alone." Ji Xiang said.

Turning around to go out, Ji Xiang bowed and smiled, "I'm sorry, Director."

"What's so embarrassing." Director Liu scolded with a smile, "Changing the dressing is a serious job, don't be so hypocritical, learn more."

As he spoke, Director Liu glanced at Ji Xiang.

"Director." Ji Xiang felt a little guilty.

"Is the treatment fee confiscated for changing the patient's medicine?" Director Liu asked leisurely.

"..." Ji Xiang sighed inwardly, but was still discovered by Director Liu.

"It doesn't matter if you change the medicine yourself, or you don't accept it." Director Liu suddenly smiled slyly, "But don't let the head nurse know, the housekeeper is very talkative."

"what?"

"The performance of the department, hey! It's a joke to say it out. While asking to treat patients and save lives, at the same time, performance appraisal, don't you think it's very split?"

"A bit."

"Let's not talk about that, it's hard to be a doctor now, mainly because of schizophrenia."

"Director, what kind of patient are you consulting?" Ji Xiang asked with a chuckle.

"The patient was admitted to the hospital because of femoral vein thrombosis in the lower extremity. The thrombolytic therapy was not good. He planned to insert a catheter for thrombolysis. He had a CT scan before the operation and found something wrong. I just looked at the film on the computer and I always felt that something was wrong." Director Liu said as he walked.

"Is something wrong?"

"Well, I don't think it's a tumor, but I can't tell what it is." Director Liu said, "The kidney parenchyma is gone, so it should be a renal cyst, but it's too big, so I dare not recognize it."

"How big?" Ji Xiang asked curiously.

"I estimate that there is 5000ml of water in it, and the parenchyma is like a piece of paper." Director Liu said suspiciously, "It is impossible to say that renal cysts are very common. Pressed into a sheet of paper..."

Ji Xiang didn't speak, and accompanied Director Liu to go to the Department of Gastroenterology.

Kidneys being crushed into a sheet of paper sounds weird.The reason why Ji Xiang didn't talk too much was because he wanted to see the patient's information.

I didn't even watch the movie, so why should I talk too much.

When he came to the Department of Vascular Surgery, Director Liu was the first to arrive. He asked for the patient's image data and inserted it into the viewer for viewing.

Although all the systems in the hospital have been digitized and films can be viewed on a computer, Director Liu is relatively old and is more used to watching films on a film reader.

Ji Xiang stood behind Director Liu and watched together.

There was a huge mass in the patient's left abdomen, about 7 vertebral bodies in length, and the width exceeded the abdominal midline.

If this thing hadn't been told by its density that it was a "water sac", anyone would have suspected it was a tumor.

But such a large "water sac" does not look like a kidney cyst.

Ji Xiang's reading ability is not high, just passed the standard line, he read the medical records carefully after reading.

The system NPC is not easy to fool. Although he rarely tests himself, once he asks a question and he can't answer it... Ji Xiang feels too embarrassed.

It has to be said that the medical records were written by physicians, which are detailed enough, and even though the patient's admission time was short, everything was rewritten.

If it is a surgical patient, even if the patient is admitted to the ICU before being discharged from the hospital, the surgical records may not be written.

After writing it down, Ji Xiang came to the system space.

"Teacher, the cyst is very big." Ji Xiang and the system NPC said after reporting.

"It's not a cyst, or it's not an ordinary cyst." The system NPC said, "It should be huge hydronephrosis."

"Teacher, do you have water in your kidneys?"

"Yes." The NPC of the system nodded, "Generally, when hydronephrosis is discovered, the kidneys will be preserved more or less. They may not function, but they can be seen on the image."

"But huge hydronephrosis..."

"Teacher, why is the name of this disease so strange?" Ji Xiang asked.

"It's very huge, there's nothing to describe it." The system NPC said, "Dr. Stirling first proposed the concept of huge hydronephrosis in 1939.

That is to say, if the amount of water in the collecting system exceeds 1 000 ml, the radiological manifestations are that the water reaches or exceeds the midline of the abdomen, occupies half of the abdominal cavity, or the long diameter of the water exceeds 5 vertebral lengths. "

"However, clinically, 1000ml of water is not considered huge. I have seen patients with more than 5000ml."

"This must be at least 5000ml."

"Yes, but the patient didn't feel uncomfortable, and he didn't come to the doctor until complications occurred. It is very rare. The venous thrombosis of the lower extremities is caused by the compression of the inferior vena cava by huge hydronephrosis, which leads to obstruction of the return and reduces the blood flow rate."

"It's relatively rare. It's normal if your director hasn't seen it."

"The principle is the same as hydronephrosis. The etiology includes ureteropelvic junction stenosis, vesicoureteral reflux, megaureter, and posterior urethral valves. 80% of patients are caused by ureteropelvic junction stenosis."

"As for the treatment..." After speaking, the system NPC paused.

"Stenosis release surgery?"

"General hydronephrosis can do this, but the kidney on the side of huge hydronephrosis has no function. If you keep it, the loss outweighs the gain. It needs to be surgically removed."

Ji Xiang nodded.

"Don't underestimate this operation." The system NPC said, "The operation of huge hydronephrosis is quite difficult. Although the concept was proposed in 1939, laparoscopic surgery has been carried out in the last century, and laparoscopy can be used to treat huge hydronephrosis. , was not reported until 1991."

"Why, teacher."

"Because of the relatively long time, the dorsal membrane and peritoneum of the kidney fuse, and the local anatomical tissue changes, making it difficult to complete the operation with laparoscopy."

"If it was an open surgery, it would be a little easier."

"Doctor Xiaoji."

"Yes." Ji Xiang replied immediately.

He was a little distressed, wondering if the system NPC wanted to experience empathy by himself.

"Let's train the operation directly. You can see me perform one operation, and then try a few times by yourself." The system NPC said, "Only after you have done it yourself can you understand why the operation is difficult."

"Don't you need to empathize?" Ji Xiang asked.

"The patient didn't feel anything before the discovery of the venous thrombosis, so there is nothing to try." The system NPC said, "If the operation fails, you can try it."

Ji Xiang clicked his tongue, not daring to raise any further objections.

(End of this chapter)