I Can See Health

   Chapter 461 Guess the diagnosis?

  Three electrophysiological surgeries in the morning cost a total of 6,000 yuan for consultation.

  Lu Chen put the envelope away for now, and prepared to communicate with Li Yao later.

   "Congratulations, +1 for the thank you from Fan Zhiping!"

   "Congratulations, +5 for receiving thanks from Yin Chao!"

   "Congratulations, +1 for receiving thanks from Lin Xin!"

  “…”

   After completing these three operations, Lu Chen also received dozens of points of gratitude.

The    system upgrade completion degree has also been improved accordingly.

   "Director Li, I booked a hotel for noon." Yin Chao said with a smile, "You and Dr. Lu can have lunch first and then rest for a while."

   "Okay." Li Yao nodded in agreement.

  Lu Chen was slightly taken aback.

   He thought Li Yao would go straight back to the hospital, but he didn't expect to stay for an afternoon.

   "Lu Chen, we also went to the Cardiology ward this afternoon." Li Yao explained.

"Um."

   Lu Chen took the envelope in his arms, got into the business van, and arrived at the reserved hotel with Li Yao.

   After eating a sumptuous lunch, after Yin Chao and the others left, Lu Chen said, "Teacher, about the consultation fee..."

  Li Yao smiled and waved his hand, "You take it, the operation is all done by you, and the consultation fee is what you deserve."

   "Teacher, but this is too much." Lu Chen paused.

   If you work two and a half hours in the morning, you can get 6,000 yuan.

   This is a lot of money for most people.

"Regular income, after the approval of the medical department and the health bureau, you can take it." Li Yao said sternly, "What's more, our electrophysiology is small, and we have more coronary interventions than us. You young people, spend money There are many places to talk about love and so on, and the usual living expenses are definitely not enough."

   Seeing Li Yao say this, Lu Chen couldn't refuse the mentor's kindness, he nodded and agreed.

   "I'll take you out for a walk when there is a chance in the future." Li Yao added.

"Thank you, teacher."

  Lu Chen knew that this was Li Yao creating another chance for herself.

   What he lacks now is the opportunity to experience.

   In addition, flying knives can also earn some extra money, which is something others can’t ask for!

  …

  After lunch break, two o'clock in the afternoon.

  Lu Chen and Li Yao came to the Cardiology ward of Fengm County People's Hospital.

  Lu Chen also learned that this time he came to the ward mainly for a patient.

   This patient is not only a relative of the dean, but also an acquaintance of the school leader.

   The patient is currently hospitalized in the Department of Cardiology, but it has been almost a month of treatment and still no improvement.

   Originally, he was transferred to Jinghua University Hospital for treatment, but the patient was old and unstable, and could not afford the long journey, so he could only receive conservative treatment in the county hospital.

  …

   This time, taking advantage of Li Yao's opportunity to come to Feng M County People's Hospital, the dean personally invited her to see people.

   "Professor Li, this patient's family is not very good at communicating!" Fan Zhiping quietly said to Li Yao, "The attitude is not very good, we usually let the director communicate in person."

   He happens to be the patient's doctor.

   For such "related" patients, they really have a headache.

   Don’t think that you are acquaintances who are easy to communicate with. A considerable number of “related” patients, relying on this relationship, ignore the rules of the department and even interfere with the process of treatment and medication.

   For example, this medicine is domestically produced and cannot be used.

  The other medicine has any side effects and cannot be used.

   But thinking about this kind of patient, Li Yao has seen a lot.

   If it wasn't for the dean's personal invitation, she would definitely not come.

  Li Yao looked indifferent and said softly, "I'm here to see the doctor, not to please the patient and the patient's family."

  Fan Zhiping sneered, a professor has such courage, these little doctors dare not do this.

   "Professor Li, should you first see the patient or the medical record?"

   "Let's see the patient first." Li Yao said.

   Then, Fan Zhiping brought the two to the ward.

  …

   This is a VIP single ward.

   The patient was half lying on the bed, the head of the bed was shaken up.

   His eyes were dull and his lips were blue and purple, but he was conscious and his vital signs were stable.

  Beside the hospital bed, there was also a middle-aged woman, who was wearing a big red wave, and she was dressed in bright and beautiful clothes.

   Walking to the bedside, Fan Zhiping began to introduce, "This is Professor Li Yao from the Department of Cardiology of the Second Jinghua Hospital, who came to see the patient on purpose."

  The big wave woman stood up immediately, a smile on her face.

   "Professor Li, please sit down."

   said, she really took out a chair and put it in front of Li Yao.

  Li Yao frowned, "I don't need to sit when I see patients. And our doctors never sit in the ward."

   "Uh." The big wavy woman's smile stagnated for a while, and then she smiled contemptuously.

   At this time, Fan Zhiping began to report his medical history.

   "The patient is an 80-year-old male who complained of chest tightness, shortness of breath, and edema of both lower extremities and was admitted to the hospital for 1 month."

"One month ago, the patient had exertional chest tightness, shortness of breath, edema of both lower extremities, loss of appetite, cough and expectoration. He was diagnosed with pulmonary heart disease and chronic obstructive pulmonary disease at the local health center, and the treatment effect was poor. "

   "Historical hypertension and chronic bronchitis."

   After listening to the introduction of the medical history, Li Yao nodded and started a simple consultation.

  Lu Chen followed behind Li Yao and performed a physical examination on the patient.

   "Clearness, distended jugular veins, clear breath sounds in both lungs, no dry or wet rales. Both lower extremities edema. Abdominal and nervous system examinations were negative."

   After the consultation and physical examination, everyone is ready to return to the doctor's office.

   However, just as he was about to leave, he was stopped by a middle-aged woman.

   "Professor Li, how is my dad's illness?"

   In front of the patient, Li Yao didn't say much, "Don't worry, I will communicate with your doctor in charge after I read the medical records, and then your doctor in charge will communicate with you."

  Li Yao was about to leave, but the middle-aged woman was still a little reluctant, "Professor Li, the dean is a relative of my family, and he came here today..."

  Li Yao paused slightly, then left the ward without stopping.

  …

   out of the ward.

  Fan Zhiping shook his head helplessly and said softly, "Professor Li, don't worry about it, she's pretty good today, but her usual attitude is much worse than this."

  Li Yao shook his head slightly: "I've seen a lot of patients like this, so go back and look at the medical records."

"it is good."

   Back at the doctor's office, Fan Zhiping frowned and said, "Professor Li, the main problem of this patient is that the treatment effect is not very good."

  Li Yao replied unhurriedly: "The treatment effect is not good, do you have any ideas?"

   Fan Zhiping stayed in the eight districts in his heart for half a year, and Li Yao also knew him.

  Fan Zhiping paused and replied, "Professor Li, the first thing I thought about was, is the drug treatment not in place? Second, is our diagnosis wrong?"

   While talking, Fan Zhiping took out the patient's medical records.

   He printed two copies of all the medical records and handed them to Lu Chen and Li Yao respectively.

  …

   After reading all the medical records, Li Yao asked, "What is your current diagnosis?"

Fan Zhiping organized the language and said: "The patient was diagnosed with pulmonary heart disease in the health center. I think the possibility is relatively small. According to cardiac ultrasound and other examinations, we consider hypertensive heart disease, heart failure, chronic obstructive heart disease. Lung disease."

   After hearing Fan Zhiping's description, Lu Chen looked at the patient's heart ultrasound report.

  The echocardiographic report showed that the left ventricular end-diastolic diameter was 40mm, the right ventricular end-diastolic diameter was 16mm, the left atrium was 46mm, and the right atrium was 59x44mm. Consistent with ultrasonographic changes in hypertensive heart disease, bi-atrial enlargement, and left ventricular systolic function were normal.

  Lu Chen knew in his heart that Fan Zhiping's diagnosis should be based on the echocardiography report.

   "But we gave antihypertensive and anti-heart failure treatment, and the symptoms of the patient's heart failure are still obvious." Fan Zhiping said.

   was diagnosed, but the treatment effect was not satisfactory, or did not have much effect.

  …

   Beside, Lu Chen continued to look at all the examinations of the patient.

  pro-BNP: 8141.02 pg/ml.

   Blood routine, liver and kidney function, QR-CRP, coagulation function, D-dimer, blood lipids, blood sugar, nail function, urine protein, and stool routine showed no obvious abnormality.

   Chest CT showed: bilateral lower lobe infection, a small amount of bilateral pleural effusion, multiple small nodules in the upper middle lobe of the right lung.

   "Professor Li, your opinion..." Fan Zhiping said slowly.

  Li Yao did not answer directly, but instead said: "What about the patient's electrocardiogram?"

   "Oh, here it is." Fan Zhiping took out the electrocardiogram from the medical record folder.

  Li Yao glanced at it, then handed it to Lu Chen, and smiled and said, "Lu Chen, what do you think?"

  Lu Chen heard the words and gave a slight pause, "According to all the symptoms and examination results of the patient, the heart failure is certain. Now it's time to see the cause of the heart failure."

   Heart failure is just the end of the disease.

  Many diseases can lead to heart failure, such as coronary heart disease, hypertensive heart disease, valvular disease, pulmonary heart disease, fatty heart disease, etc...

   "I don't think this patient has pulmonary heart disease or hypertensive heart disease."

   Lu Chen's words left everyone present stunned.

   Cardiac ultrasound report, all have written hypertensive heart disease.

   Why is it not right?

   Fan Zhiping wondered, "Coronary heart disease?"

   "No." Lu Chen shook his head.

   "Fat heart disease?" A doctor said.

"no……"

   "Valve disease?" Another doctor said.

  Lu Chen is quite helpless, who is this, want to guess all the diagnoses?

   (end of this chapter)