MTL - Since 1981 Health School-Chapter 89 Chen Qi's diagnosis

  Chapter 89 Chen Qi's Diagnosis Basis

  Dean Guo and the others were not in a hurry, drinking tea and chatting while waiting for the serious medical records to come in.

  About half an hour later, Zhang Jun knocked on the door and came in, holding a recently completed medical record in his hand.

  Seeing Zhang Jun coming in, Qi Damin asked, "Have you finished writing?"

   "Report to Section Chief Qi, I have written all the major medical records and the first medical course records, please have a few teachers look at them."

  Qi Damin took the iron clip and handed it to Dean Guo who was sitting in the middle.

  Dean Guo was not too polite. He opened the medical record and looked through it. After all, he was a college student. His writing was standard, clear and organized. He did have two brushes.

  Dean Guo nodded and flipped through the pages until he turned to the diagnosis page, his hands and eyes stopped.

   "Student Zhang, your diagnosis is cholangiocarcinoma, right?"

  Zhang Jun swallowed nervously: "Yes, Dean Guo."

   "Oh, tell me about your diagnosis?"

"My main diagnosis is based on the B-ultrasound sheet. The patient has dilated intrahepatic bile ducts, empty gallbladder, and soft tissue shadows in the upper part of the common bile duct, but the caliber of the extrahepatic bile ducts is normal. This can basically be judged as hilar cholangiocarcinoma, and has already It's late."

  President Guo smiled and said nothing, but handed the medical records to Qi Damin next to him, motioning for everyone to pass them on.

   Just when Jin Peilin was the last one to read the medical records and had no time to praise Zhang Jun, Chen Qi also knocked on the door and came in.

   "President Guo, Section Chief Qi, Director Zhu, Director Jin, my serious medical record has been written."

  Qi Damin nodded: "Sit next to me for a while first."

  When Dean Guo got Chen Qi's serious medical record, the first thing he saw was the beautiful pen writing in his hand. The pen was strong and powerful, which made him nod in his heart.

  The entire serious medical record was written down, which is more detailed than Zhang Jun's, but if you really want to score, the scores of the two are similar. However, Zhang Jun is a college student and Chen Qi is a technical secondary school student. If they have the same score, Zhang Jun will lose first.

  Dean Guo didn't comment, and turned to the page of diagnosis, and then his eyes lit up:

   "Student Chen, you diagnosed hilar bile duct stenosis, cholangitis?"

  As soon as these words came out, the interest of everyone in the office was instantly aroused, and everyone's dull mood suddenly became active.

  Because the diagnoses of Chen Qi and Zhang Jun are completely different, it means that this game is destined not to be a draw, and there must be one person who will lose completely, so there will be a good show.

   Zhang Jun was a little surprised when he heard Chen Qi's diagnosis:

   "Chen Qi, you didn't see the B-ultrasound sheet saying that there is a soft tissue shadow in the upper part of the common bile duct, such an obvious tumor."

  President Guo handed the medical records to Qi Damin next to him, and asked with a smile:

   "That's right, why did you rule out such a big thing? I'll show you two more inspection reports. These were done by the patient in the outpatient clinic in the morning, and the results just arrived."

  President Guo handed over two pieces of paper,

  One is a B-ultrasound imaging report, indicating that the lumen at the bifurcation of the left and right hepatic ducts is narrow, and a lump of 2.7cm*1.4cm in size can be seen in the common hepatic duct after contrast agent injection.

  The other one is an X-ray film report, suggesting that the hilar bile duct is narrowed again, and the upper intrahepatic bile duct is widely dilated, and the common bile duct and pancreatic duct are not narrowed or dilated.

   Zhang Jun looked even more proud after reading it, feeling that his diagnosis was stable.

  After Chen Qi looked at it, he just gently placed the two report sheets on the table, without any frustrated expression on his face.

  Dean Guo looked at Chen Qi playfully, and asked with a smile:

   "How about it, do the two students need to revise their initial diagnosis after seeing these two reports?"

  Zhang Jun shook his head firmly: "These two reports further confirm that my diagnosis is correct, and there is no need to change it."

  Chen Qi smiled: "Yes, these two reports also made me more determined to rule out the diagnosis of malignant tumors."

  President Guo leaned back on the back of the chair, looked at the many doctors in the room and asked, "Come on, tell me, which diagnosis do you agree with more?"

  Li Jun was the first to stand up: "Dean Guo, I agree with Zhang Jun's diagnosis. This is a very obvious space occupation, and it is still at the hilum of the liver. The possibility of malignant tumor is the greatest."

   Several other young doctors also nodded, obviously everyone agreed with Zhang Jun's diagnosis.

  President Guo looked at several experienced doctors again: "Lao Qi, Lao Zhu, and Director Jin, please talk about it, let's treat it as a big discussion of departmental cases today."

  Qi Damin was born in internal medicine. After reading a few reports and the physical examination results in the big medical records, he tended to be cholangiocarcinoma.

  Zhu Huoyan carefully looked at several report sheets, and then glanced at Chen Qi. Obviously, he was inclined to Chen Qi's diagnosis, but because Chen Qi hadn't specified the basis for his diagnosis, he didn't offer support.

  Jin Peilin remained silent. With a few big bosses around, he, the little head of the department, shouldn't show too much.

  President Guo saw that everyone in the office was inclined towards Zhang Jun, so he said with a smile:

"Student Chen, you see. Everyone's diagnosis is that bile duct cancer is very likely. If you want to say that it is ordinary cholangitis, then tell me the basis of your diagnosis. Be careful, don't talk about it, we doctors must embrace it. A realistic attitude.”

  Chen Qi let out a sigh of relief. As a hepatobiliary surgeon in his previous life, he was confident that his diagnosis would not be wrong. After all, he had dealt with too many cholangiocarcinomas before.

   "Dean Guo, several teachers, I judge from these angles.

  One is that the clinical manifestations of the patient do not match. He does not have jaundice. Neither the results of the laboratory test sheet nor his own complexion suggest jaundice. In addition, the patient has no symptoms such as skin itching, weight loss, indigestion, and upper abdominal discomfort. "

  Chen Qi began to talk about the basis of his diagnosis, and the office quickly fell silent.

  Everyone is a professional doctor. Although he has a tendency in his heart, he also understands the truth that listening and listening make clear.

  Zhang Jun deliberately objected, wanting to say that not every cholangiocarcinoma will have the above clinical manifestations, but he held back. He interrupted when others were reporting their illness. Whether it was right or wrong, it would leave a bad impression on the leaders.

  Chen Qi ignored everyone's thoughts and continued following his own train of thought:

"In addition, the two lists given by Dean Guo just mentioned that if it is cancer, there is no intrahepatic metastasis and concomitant lesions, and no vascular invasion is found, and the hilar lymph nodes have not swollen, so the inflammatory lesions can not rule out.

   There is another basis, which is the tumor index on the physical examination form. You can see that the carbohydrate antigen 19-9 is normal. So just a biliary stenosis or a soft tissue shadow is a malignant tumor. I think it is unlikely. "

  As soon as these words came out, everyone began to meditate.

  (end of this chapter)