Doctor of Healing

Chapter 27 The Kidney That Disappeared Inexplicably
It didn't take long to empathize this time, but the shock that Ji Xiang received was far more than that when Hai Hai performed the lengthening operation.

As for the pain, bleeding, infection, etc. after the circumcision, compared with the same experience this time, it is not enough.

As a result, Jixiang didn't take stock of the gains in the first time.

It may be because of the increased difficulty of empathy, this empathy gave Ji Xiang 30 surgery points.

But he was in a bad mood, and his eyes were full of blood.

I don't know how things will develop after I leave, Jixiang thought silently.

"Teacher." Ji Xiang pursed his lips, not agreeing with the statement of the system NPC.

"Doctor Xiaoji, tell me your analysis of this matter." The system NPC looked at Jixiang and asked calmly.

Although he knew that it was just an illusion, or a program, Ji Xiang remained calm for a long time.

The system NPC handed him a bottle of 10% 250ml glucose, and Ji Xiang drank half of the bottle before gradually calming down.

Looking at Ji Xiang quietly, the system NPC did not interrupt his thoughts.

"The surgeon who participated in the rescue three years ago was at fault for this matter, but the patient was emotional, and it was not right to injure innocent people." Ji Xiang simply stated his judgment.

"The basic knowledge is still weak, so that your judgment on the whole thing is wrong." The system NPC shook his head.

"Huh?" Ji Xiang was taken aback when he heard the system NPC say that.

The patient's right kidney disappeared, this thing is a certainty, how could the system NPC say that!

Is his butt sitting crookedly?Even in the system space, his butt is still crooked? !

No wonder it is said that the butt determines the head, and it turns out that is the case.

Ji Xiang felt a little disdainful in his heart, and the young man's blood began to surge. Even if he wanted to offend this extremely powerful system NPC, he had to stand on the side of justice and justice.

The system NPC did not laugh, but looked at Ji Xiang's expression seriously.

He seemed to guess what Ji Xiang was thinking.

This young man was ready to challenge himself like a little beast, completely forgetting the real purpose of coming to the system space this time.

The old and the young were silent, and the atmosphere in the operating room of the system was inexplicably awkward.

After 3 seconds, the system NPC broke the suffocating silence.

"There is a type of disease called kidney autotomy, which is more common in tuberculosis patients." The system NPC waved his hand, and a light screen appeared in front of him, and he began to tell Ji Xiang.

Ji Xiang frowned and had his kidney amputated, which was described in very little space in diagnosis and other courses.

Although Jixiang has memorized almost all the textbooks of his height by virtue of his superhuman memory, it is just a boring memory, and it is impossible to turn it into an ability.

"A large amount of calcium salt deposits in the renal tuberculosis lesions, resulting in extensive calcification of the entire kidney. The sonographic feature is that the kidneys are damaged to varying degrees, and even calcified. When the renal function is completely lost, the ureter is completely occluded.

This condition is clinically known as renal autotomy or putty kidney. "

"Teacher, the patient has no history of tuberculosis." Ji Xiang tried to recall the memory of empathy, and argued.

The system NPC raised his deformed, chicken paw-like right hand and pressed it.

"Renal self-amputation is a type of disease, and there is another branch disease that we call traumatic renal self-amputation."

"..."

This sentence poured down like a basin of cold water, and the anger in Ji Xiang's heart was extinguished immediately.

Traumatic renal autotomy, as the name implies, involves trauma that can cause kidney problems.

Combined with all the empathy, Ji Xiang naturally thought of the words of the director of the Department of Urology, the purpose of coming to the system space, and the emotions of the patients after they knew that their waist was pinched.

The system NPC didn't care about Ji Xiang's feelings, he continued to explain.

"The patient was diagnosed with liver rupture and kidney contusion 3 years ago."

"Renal contusion and laceration can be seen on CT scan with uneven density, blurred or cracks in the renal tissue or hematoma in the renal parenchyma and subcapsular hematoma; it can be seen more clearly with enhanced CT."

"Kidney contusion and laceration lead to a series of complications such as hematuria, and the easiest way is to remove the kidney.

Due to the importance of the kidney to people, of course it can be removed without surgery as much as possible.It is a clinical treatment guideline to keep the organs as much as possible.

For those with hematuria or continuous bleeding, arteriography can find the problem, and high-selective embolization can be performed, that is, the bleeding branch blood vessels are blocked to stop the bleeding and preserve the kidney. "

The system NPC began to tell Jixiang about the kidney contusion and laceration, and then about the kidney rupture.

Normally, Ji Xiang must think that the system NPC is a bit nagging and didn't go straight to the point.

But this time he listened carefully, and cross-referenced with the knowledge he had learned in school.

"The fifth type of injury is renal vascular injury, which can be divided into two situations.

The first is renal vessel rupture, which can be one of the arteries and veins or both. This can also be counted as renal rupture, or renal pedicle rupture. It is also a serious disease that will cause death from hemorrhage without prompt surgery. "

"The second one requires you to pay special attention."

The system NPC reminded Ji Xiang with an accentuated tone.

Ji Xiang nodded, looking at the light screen.His brain is divided into several different threads, while thinking about the emotions of the patient, himself, and the doctor in the CT room when he empathizes, while listening to the teachings of the system NPC.

"If the renal artery is contused, the main problem will be in the blood vessels. The patient was sent to the operating table during emergency treatment, and the laparotomy showed that the shape of the kidney did not change, and there was no indication for surgery."

"Even if it was an emergency CT at that time, there would not be any problems found."

"Teacher, if you want to do 64-slice CT, it's the kind that sprays medicine." Ji Xiang asked.

"Not to mention whether emergency patients can give you time to do this kind of examination, even if it is done, there is a high probability that there will be no diagnosis."

"..." Ji Xiang was speechless.

"Injury to the renal artery causes the intima of the vessel to become rough, the fluid dynamics are changed, and the gradual formation of thrombus is easy.

From incomplete to complete blockage of the renal artery; the fastest is several hours after injury, and the slowest is more than ten days after injury, or even changes in dozens of days. "

"I'm asking you." The system NPC looked into Ji Xiang's eyes.

Ji Xiang was a little flustered by those bright and transparent eyes.

He already understood what the system NPC said. Although he was not very clear, he knew that he had made a huge mistake in the process of empathizing with him.

"If the trauma patients are successfully rescued, how long will it take to leave the hospital?"

"10-14 days, without infection or other accidents." Ji Xiang replied.

"Hmm." The NPC of the system nodded, "It's okay for the patient to have a simple follow-up examination after surgery. Will you prescribe a more expensive angiography examination for the patient?"

"will not."

Ji Xiang answered seriously.

"Yes." The system NPC said, "This is a secondary disease. The doctor has experience and told the patient to go to the outpatient clinic one month after discharge to see if there is any change in the kidneys.

But it has almost recovered, and most patients will forget about it after they are discharged from the hospital. "

Ji Xiang let out a sigh of relief, as for the complicated mood in his heart, even he himself couldn't explain clearly.

"After renal artery contusion, the most serious situation is that the injured kidney completely loses blood supply, and of course it will gradually atrophy with ischemia.

It was also called "sterile necrosis".

The tissue of normal kidney structure gradually disappears under the condition of ischemia and necrosis, and is replaced by connective tissue similar to the surrounding tissue, which cannot be seen on CT at all. "

"That is to say, the patient's right kidney was not cut off, but because of traumatic self-amputation due to extremely rare renal artery contusion, and necrosis itself?" Ji Xiang found this logic difficult to accept.

The system NPC nodded.

Ji Xiang was silent.

He still had something to say in his heart, but he didn't say it.

"You mean to say that the doctor is still responsible." The NPC of the system seemed to be a god, seeing through Ji Xiang's heart, and asked lightly.

"Yes." Ji Xiang didn't hide it, and replied with a nod.

"Let me give you an example." The NPC of the system said seriously, "There was such a patient in the Department of Neurosurgery of our hospital - a car accident injury, a very slight scratch, and the patient was wearing a seat belt."

"Trauma, you know it too."

Ji Xiang was taken aback. The system NPC said something simple, but he probably only knew a little bit, and couldn't understand anything more.

If trauma patients have insurance or the other party is fully responsible, they will basically choose to be hospitalized.

One is just in case, and the other is that it is also good to have a full physical examination by the way.

"The patient is a young woman. After 6 days in the hospital, all the examinations showed no problems, and she was going to be discharged the next day. The doctor on duty that day saw the patient get up to go to the bathroom after the emergency operation. Everything was normal."

"However, less than an hour later, the nurses took over the shift at night and found that the patient was incontinent and unresponsive."

"!!!" Ji Xiang was stunned.

"It's too late to bring the doctor here at this time." The system NPC sighed, "The probability of one in 19 carotid artery intima is avulsed, causing a large number of embolisms in the blood vessels in the patient's head, and eventually blocking the brainstem. Died [-] days later."

"!!!"

"These two cases are somewhat similar." The NPC of the system brought the topic back, "You are correct in thinking that if the doctor is a high-level doctor, you can prevent it early, but that requires a doctor of my level."

Having said that, the system NPC paused.

"The probability is one in [-]. How many similar patients do you think there are in the whole country?"

Ji Xiang no longer paid attention to the words of the system NPC "Versailles". He frowned and asked, "Teacher, if it is discovered early, is there a cure?"

"That's something you don't think about until your urology skills reach level 9." The system NPC said, "Now I ask you, do you know the mystery of the urology director's focus?"

The reason for not paying attention to patients with extremely difficult partial nephrectomy and many postoperative complications, but to pay special attention to a patient with renal contusion appeared in front of Ji Xiang.

He knew that the director of the Department of Urology would definitely not pay attention to all renal contusions, but vaguely guessed that the patient might have problems based on his difficult clinical experience, and he needed to observe more and communicate with the patient and the patient's family to avoid accidents.

This is full of clinical experience.

Ji Xiang didn't nod, but began to ask the system NPC some questions that he didn't understand.

This does not require surgery points, and the system NPC belongs to the best kind of teacher, Ji Xiang will definitely hold on to it, and he has to study it thoroughly before talking about it.

(End of this chapter)