The road to the rise of great doctors

Chapter 11 Why is the appearance declining?
Liu Dong glanced at Wang Wen, who had a typical "moon face, buffalo back, acne, and purple lines."

Then he said to Song Dachuan: "Director, the patient's symptoms seem to be excessive secretion of glucocorticoids. Combined with the CT scan, a new adenoma in the adrenal gland was found, and Cushing's syndrome was initially diagnosed."

"Well, that's right." Song Dachuan said with a smile to Wang Wen: "Symptoms such as gaining weight are due to a hormone-secreting tumor growing on the adrenal gland. You have also heard what Dr. Liu said. This disease needs to be hospitalized." What do you think about the surgery? Once the hormones are normalized after the surgery, I can continue to look beautiful."

He glanced at the waiting list of the outpatient clinic system. It was just after 13 o'clock, and Song Dachuan couldn't help feeling a sense of teaching for the patients who hadn't yet waited for treatment.

While waiting for Wang Wen to think, Song Dachuan began to ask Liu Dong, "What else do you know about this disease? It's just right to tell the little girl more about it."

"Cushing's syndrome, also called hypercortisolism, is a clinical syndrome caused by excessive secretion of glucocorticoids."

Liu Dong paused for a moment, then continued: "According to the cause and pathogenesis, it is divided into three categories: adrenocorticotropin-dependent, adrenocorticotropin-independent and iatrogenic. Generally speaking, the first two are more common, and the second is adrenocorticotropin-dependent. One is that the pituitary gland or certain tumor tissues other than the pituitary gland secrete too much adrenocorticotropic hormone, which stimulates adrenal cortex hyperplasia and produces excessive cortisol, commonly known as hormones. This is the most common It’s Cushing’s disease caused by pituitary microadenoma. Simply put, it’s a tumor on the pituitary gland, which is a neurosurgery disease.”

"The second type is a tumor in the adrenal gland, usually an adrenal cortex tumor or hyperplasia, which results in excessive secretion of hormones. The tumor may be a benign adenoma, a malignant cortical cancer, or a large nodular hyperplasia of the bilateral adrenal glands. .”

"The third type is related to long-term oral administration of hormones or hormone-containing drugs. If common diseases require long-term oral administration of hormones, you will need to go to the hospital for regular follow-up visits to see if the hormone levels are significantly increased. If the levels are increased, the dosage will also need to be adjusted. "

Song Dachuan nodded in approval and said: "You have a good grasp of knowledge. In addition to diseases of the urinary system and male reproductive system, urology also includes diseases of the retroperitoneal cavity. Among them, surgical diseases of the adrenal gland are the main diseases of the retroperitoneal cavity. These are all divided according to anatomical parts. The reason is simple, the anatomy of these places is most familiar to urologists."

After he finished speaking, he turned to Wang Wen and said: "What do you think about it? Hormones are low-content and powerful. You have something growing on your adrenal glands. According to the surgical principles, you need to have surgery within a time limit. If you don't care, , more hormones are secreted, which not only causes obesity, but also causes high blood pressure, diabetes, hypokalemia, mental disorders, hematopoietic abnormalities, etc. The longer it is delayed, the more likely it is to be dangerous.”

Song Dachuan continued: "But if you plan to be hospitalized, you should also tell your family that you need at least one person to take care of you. The hospitalization time is estimated to be 1-2 weeks. You also need to conduct a comprehensive examination after admission, although there is a probability of problems elsewhere. Low, we still need to check everything.”

After Wang Wen heard this, he was almost frightened to tears.She held back her tears and said timidly: "I'm in the hospital. I'll call my family and go to the hospital."

Liu Dong was nearby and quickly took a hospitalization form and filled it out while comforting Wang Wen.

After filling it out, he handed it to Song Dachuan and said, "Director, please look at it like this, is it okay?"

Song Dachuan reviewed it, stamped it, and handed it to Wang Wen, saying: "Although this is rare, we urologists have seen it a lot. Surgery has certain risks, but this risk is long-term excessive secretion of hormones and metabolic disorders. Brought here. The operation is not that difficult. You don’t have to worry too much. Just go to the hospital with peace of mind. After checking in today, you will do a checkup first and if you have any questions, please contact our doctor on duty."

Wang Wen held the hospitalization form tightly with both hands and said thank you several times in a row.

The afternoon passed quickly.

Because Liu Dong behaved very calmly and had solid medical knowledge, Song Dachuan was also willing to provide opportunities.

Whatever Liu Dong can do, leave it to him.If he doesn’t know how to do it, he will be taught by him.In this afternoon, Liu Dong completed a total of 10 operations: 6 dressing changes after skin circumcision, 1 replacement of cystostomy tube, and 3 catheterizations.

"Director Song, your outpatient volume is quite large today." Seeing that the patients had finished reading, the nurse at the outpatient clinic ran to the door of the clinic and said, handing over a bottle of iced black tea.

"I have a thermos cup and health tea." Song Dachuan did not take the drink.

"Look at my memory, the director is good at taking care of it, haha." The little nurse chuckled and said: "It's almost time to get off work. You must be exhausted. If there are no patients later, I will clean the dressing room. .”

"Thanks to our Liu Dong, not only he is handsome, but he is also very handy in operation. He helped me a lot." Song Dachuan praised Liu Dong first, and then continued: "There are no more patients, you go Get busy. You've had a hard day."

The little nurse smiled and went on her way.

Liu Dong brought Song Dachuan another cup of hot water, followed what Song Dachuan said just now, and used his acquired LV3 ability to observe words and emotions, and praised Song Dachuan comfortably.

Then he said to Song Dachuan: "Director, can I participate in learning during the operation on the adrenal patient just now? As soon as I came to the hospital, I heard that you did a great job in the operation, but I haven't seen your clever tricks yet!"

Song Dachuan slowly tasted his health tea, enjoying the rest time brought by the absence of patients, and said: "If you want to see Corey's surgery, you can come. You have also participated in the diagnosis of this patient. When the time comes, you can Get on stage and feel the feelings.”

"Thank you, Director!" Liu Dong looked at him gratefully.

Urology surgery is also divided into medical groups, and some hospitals are even very strict in dividing sub-specialties. You can do it if you want, but if you want to have surgery, you must obtain the consent of the surgeon.

Zhu Guoliang's medical group mainly treats men's and prostate diseases.In most cases, he only goes to see the kidney and bladder surgeries. Unless there are few people or he changes groups, he can go on stage to participate in the surgeries of other groups.

This time Liu Dong took the initiative to come to the clinic, which seemed to be the right thing to do.

On the one hand, outpatients and inpatients are still different. Inpatients basically perform surgery, while many outpatients can take medicine home for treatment, or some simple operations, or consultation.

On the other hand, while gaining more knowledge, I also gained additional opportunities to perform some common operations. Some departments even want to ask a consultant to help with catheterization operations.It was an unexpected surprise to finally get the opportunity to participate in adrenal surgery.

So, in addition to what you have done and seen before, what other surprises will there be in the next two weeks of urological surgery rotation internship?Liu Dong was looking forward to it.

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(End of this chapter)