A hundred days after signing in, the first surgery shocked the world!

Next, there is simple post-surgery.

The nurse came up, rinsed with saline, changed the gauze pad, counted the instrument dressings, removed the shoulder pillows, placed drainage tubes...

This is followed by disinfection of the skin around the incision with a 1% vigorous iodine cotton ball.

A routine set of formalities is done...

Lin Feng left the operating table, and the rest was stitched up by the second assistant Song Ziming.

Count the items and start stitching.

Suture the latissimus neck muscles, with edentless forceps, small needles, intermittent sutures of silk threads...

At this time, Lin Feng couldn't help but prompt the second assistant Song Ziming:

"Old Song, pay attention, the patient is a fat man with a lot of body fat. The subcutaneous tissue should be sutured in full thickness during suturing, leaving no dead space. When tying knots, the movements should be gentle to avoid cutting adipose tissue and causing dead space formation. If the subcutaneous adipose tissue is too thick, it is estimated that there is a possibility of fat liquefaction, and a rubber sheet should be placed under the skin to drain necrosis and exudate, and then removed after 24~48h. "

Zhang Yuan, who had already gone to brush his hands, his shoulders trembled.

Muggles!

Are you the devil?

This detail control is too detailed, right?

You're awesome!

Song Ziming smiled: "Okay, Teacher Lin!"

Harvest the guidance of Lin Feng, experience +1+1+1...

End of surgery.

Pushing the fat man's flat cart, he returned to the ward.

......

......

At night

Lin Feng was chatting with nurse Xiaoli.

No way, as an emergency trainee dog, an average of 20 hours out of 24 is in the emergency department, and chat is the daily entertainment of emergency doctors.

Night shift doctors and nurses chat – tell each other jokes.

It was Lin Feng's turn: "In other words, a patient had abdominal pain at night, the intern doctor asked the superior doctor, the superior doctor said, call 6542, after a while, the intern came again and said: Hit, no one answered!"

"Ahhh

Xiaoli burst out with a smile.

At this time, the two patients happened to be supported and arrived at the door of the emergency department doctor's office, but they looked at each other, confused and did not understand.

This kind of joke has a certain professionalism, and only doctors and nurses can understand it.

6542, also known as scopolamine, is an anticholinergic drug that has the effect of relieving smooth muscle spasm, so it is commonly used clinically to treat abdominal pain caused by gastrointestinal colic, intestinal spasm, biliary colic, renal colic and so on.

In addition, organophosphorus pesticide poisoning, as well as microcirculation disorders can use this drug.

"By the way, it's time for apples!"

Xiaoli laughed hilarious and suddenly remembered something.

"Apple? What apple?"

Lin Feng was stunned.

"Dr. Lin, don't you know, Apple is ~~ our emergency department for it." It's in that corner. There is an incense burner and 7 apples stacked together, to keep our emergency department safe and safe night shift, and not so many patients. Otherwise, if you hit the evil door, you will be busy dying!"

Lin Feng couldn't laugh or cry.

Forgot, God of the Night Shift!

"You have culture, but you can't not believe it!"

Xiaoli complained: "Wasn't it the night before yesterday? suddenly came 5 or 6 waves of stomach trouble, in the middle of the night, lying corridors all over the floor, evil doors!"

Lin Feng pouted: "It's already late!"

"What?"

Xiaoli was stunned: "Why is it late?"

"At the door, there are already patients here!"

Lin Feng pointed to the door of the office, two patients supporting each other.

Xiaoli had a black line and thought brokenly: "It's really dishonest! Don't blame the god of the night shift! I'll change the tribute fruit for your old man~~"

"Let's help the patient in for examination first." "

Lin Feng glanced at the two patients.

It's really strange, it's actually ~~

Two crooked nuts?

They are all very young, a man and a woman, estimated to be around 20.

Among them, the girl was pale, covered her stomach and sat opposite Lin Feng, frowning.

The man knows a little Chinese, and even gestures, mixed with stiff Chinese: "Doctor!

"What's wrong with her?"

Lin Feng asked.

"She can't eat anymore... Thing, what's that called, dry food! Yes, I can't cook for three months. "

The man gestured.

Dry rice?

Lin Feng couldn't laugh or cry~~

What kind of Internet memes are these?

It's all funny!

Take the crooked nuts that were originally said to be unfavorable, completely crooked!

The mouth is full of funny terriers!

What the hell is it with a Northeast Obalko accent?

"I said you don't speak Mandarin?"

Isn't what we're talking about the most standard drop Mandarin?"

Mike looked confused.

Lin Feng: "···· Where did you learn this Mandarin?"

"Before I came to Xia Country, I told an old Northeast Iron Xuedi in the United States, he was from the international big city Gangling!"

Mike looked proud.

Lin Feng covered his face ~~

Poor baby!

Lin Feng saw that he spoke Chinese, which was really awkward, and simply asked in fluent English: "Let's speak in English!"

"What? You speak English so well?"

Crooked nuts were overjoyed, and Xiaoli stared at the dog.

Lin Feng pouted.

Doctors' English is originally good, after all, you have to read a lot of original English papers, and even many textbooks are in English.

Coupled with the check-in system, Lin Feng has countless experiences, and it is not a problem!

Lin Feng spoke fluent English, communicated with the two crooked nuts, and basically understood the situation.

Patient, female, Goliath, Yiduli American, 19 years old, and her boyfriend Mike came to Xia Guo to study Chinese for half a year, due to indigestion and loss of appetite for three months, tonight had a serious seizure to come to the doctor.

Goliath said to herself: "Doctor, when I had abdominal pain, my stomach was like a knife. "

"Location?"

"Spread to the right upper quadrant. "

"Duration?"

"It lasts about 3~5 hours a day. Occasionally, he wakes up at night with abdominal pain. No diarrhea, no nausea and vomiting, no weight loss, no change in bowel habits. "

"You hurt for so long every day, and you didn't come to see a doctor for 3 months?"

Lin Feng was surprised.

"I, I practiced gymnastics before, I think that after coming to Xia Guo, I didn't pay attention to it. The pain is not very bad. "

Goliath said embarrassed.

Lin Feng was speechless.

There is a reason why there are fewer crooked nuts!

Sure enough, the skin is rough and thick series!

These people, advocating natural remedies, would not have come to the hospital if they had not made a lot of noise. They may not be familiar with or trust Xia's medical and health system, and their level of worry is limited.

Lin Feng could obviously feel that Mike and Goliath sometimes talked about the level of themselves and Doctor Xia Guo, and if they didn't know that Lin Feng understood English, they would have gone back.

Lin Feng pouted.

This foreigner is still looking at Xia Guo with the eyes of the past!

I thought Xia Guo lived 20 years ago?

Xia Guo's current medical and health conditions, as well as the level of Xia Guo's doctors, are they no longer good than before?

Lin Feng sees through and doesn't say broken, let's use facts to speak.

Lin Feng continued to question, and Goliath admitted that she began to have a fever two days before her visit, and her body temperature reached 39.9.

Lin Feng was shocked in his heart.

I wipe ~

This foreigner fever fever?

Wouldn't it be... Some kind of infectious disease, right?

Fortunately, Lin Feng himself has a strong sense of protection, and masks, hats, gloves, and goggles are not dropped.

Emergency department doctors, who are high-risk departments, need to be constantly fully armed, otherwise they can easily be infected.

Goliath continued to state her condition, with some erythematous itching on her upper limbs, hips, and buttocks. No cough, no abnormal urination.

Lin Feng pondered for a moment, considering the cause of this woman's condition.

When a doctor sees a doctor, what he says is divine, it is nothing more than finding the cause and prescribing the right medicine, and so on.

From what she described, the main problems were indigestion and fever.

Indigestion may be associated with gastroesophageal reflux, peptic ulcers, or tumors. Fever may be associated with infectious or malignant illness. For example, chylogenic diarrhea may present as gastrointestinal symptoms with a rash and itching. When dyspepsia is accompanied by weight loss, anemia, dysphagia, digestive endoscopy is recommended to exclude tumors.

Lin Feng continued to chat with Goliath, asking about her condition and travel history, and further judging the possible causes.

Mike interjected in broken Chinese: "Doctor, my daughter-in-law, I have always been old... Dead strong! You know?"

"Old... Dead strong?"

Lin Feng was stunned.

"It's just, English, strong! Huh?"

Mike stretches his right arm, biceps pose.

Lin Feng: "····"

Please don't speak Chinese well, don't talk nonsense!

It's English and Northeast Chinese, which makes me confused.

Goliath glared at Mike and continued to state.

She is previously healthy, has no history of surgery, and no history of medication. The physical examination 6 months before this visit showed that the blood routine, liver function, and kidney function were normal.

The patient lives with her boyfriend, Mike, and has a pet dog at home.

Three months before she came to the clinic, she had returned to visit her relatives. I once ate cold cress in Yiduli, and I experienced obvious discomfort in my upper abdomen half an hour after eating.

Goliath said: "After this, I always had repeated upper abdominal discomfort. "

"Chilled cress?"

Lin Feng's eyes flashed: "You said, after you ate for half an hour, your upper abdomen began to feel uncomfortable?"

"Right. "

Lin Feng pondered slightly.

Acute gastroenteritis is common in travelers and has a variety of pathogens.

However, unlike this case, most cases of acute gastroenteritis are self-healing, and unlike this case, patients often develop diarrhea and are rejected.

Norovirus can cause chronic gastroenteritis in immunosuppressed patients, but this patient has no history of immunocompromise, which is rejected.

At the time of presentation, the patient's vital signs were normal, scleral jaundice, and abdominal examination was free of hepatosplenomegaly, and he was again rejected.

Lin Feng thought about it and decisively waved his pen~~

Open the checklist!

"Blood routine, liver function, tumor markers, CT, ultrasound..."

Lin Feng said lightly: "Now that there is no one on the night shift, the results should be available soon." "

The reason why Lin Feng said this was because he found that this pair of crooked nuts already had the meaning of retreating.

In particular, Golia, who seems to be very distrustful of Xia Guo's medical level, wants to go back to the United States for examination between words, but the old iron Mike with a big northeastern taste has been persuading her to check it on the spot, otherwise it is too torturous and easy to delay treatment.

Mike also mentioned that in the United States, this non-fatal and dangerous chronic disease often has to be booked months in advance, and it may not be possible to see it, and it often takes a year and a half to cure.

A year and a half?

Lin Feng simply wanted to laugh.

In Xia Country, this kind of efficiency does not exist!

It is often Dr. Xia Guo, who has not been cured for three days, and the patient has already scolded.

Smash the hospital all!

Who dares to give treatment for a year and a half?

Listening to Lin Feng say that Xia Guo's night shift was very efficient, plus the stomach hurt and couldn't stand it, it was estimated that he couldn't survive his hometown in the United States, so Goliath was reluctant to go for the examination.

The efficiency is really high.

Just an hour later, Lin Feng got the experimental inspection results.

Blood routine: eosinophils greatly increased...

Liver function: ...

Tumor markers: None...

· HBV, HCV, HEV infection indicators, negative, none;

Lin Feng's heart is like a mirror, and he already knows it in his heart.

These test results, there is no other big problem, the only thing is peripheral blood eosinophilia!

.........

.........

Ye Xuan continued to read the inspection report.

ct: No problem.

Ultrasonography: abnormalities in the liver, poorly demarcated hypoechoic areas in the liver, and no intrahepatic and extrahepatic ductal dilation.

Lin Feng began to reason at the speed of light~~

Normal sebanol levels rule out adrenal insufficiency!

· Negative ANCA antibody test to exclude eosinophilic granulomatous disease with polyangiitis!

Slightly elevated vitamin B12, which may be related to liver cell damage!

A string of thoughts passed by Lin Feng's eyes at the speed of light~~

She has obvious digestive symptoms and significantly increased peripheral blood eosinophils, so the possibility of parasitic infection is greatly increased!

"You go for another CT with your upper abdomen!"

Lin Feng instructed.

"And more?" Goliath was visibly unhappy.

"Let's go, soon find the cause~~" Mike Laotie pushed her to go.

Soon after,

Enhanced CT reports back.

Epigastric CT with contrast: there is a flaky low-enhancement area in the liver parenchyma, and lymph nodes around the portal vein are enlarged!

"Do you have cats and dogs in your family?"

Lin Feng asked.

"Yes, I have a dog! She has a cat!"

Mike was quick to talk.

Lin Feng said in a deep voice: "Since you have a history of contact with pet dogs, you also consider that it is caused by Toxoplasma infection, which can explain abdominal pain and eosinophilemia, and also explain the lesions with unclear boundaries in the liver." "

"However, Toxoplasma infection is generally more common in infants and young children, and the primary lesion is usually in the lungs. "

"Your chest x-ray is fine, this rules out Toxoplasma infection!"

Lin Feng's eyes flashed: "You said it yourself, half a year ago, you would have ingested cold cress during your travel?"

"Yes!" Goliath had abdominal pain, her face was pale, and she said impatiently: "You have asked so much, is there any way to judge my illness? "

Lin Feng despised.

Going to the United States?

Wait half a month, I see you have half a life left.

If I wasn't a doctor, I'd kill you!

"According to your description, gastrointestinal reactions occurred after you consumed it, and then epigastric discomfort occurred after this event, so the infection in the liver caused by ingesting edible aquatic plants became the biggest doubt!"

"Fascioliasis of the liver became the biggest suspected diagnosis. "

"Originally, you could have obtained the relevant parasite identification through a liver biopsy. But liver biopsies are invasive, and we don't have that equipment in the emergency department!"

"Then draw blood and test it with a serum sample!"

Lin Feng said quickly.

Goliath was half-convinced: "Cold cress, just because I ate a meal of my aunt's cold cress?"

"Yes!"

Lin Feng said lightly: "As far as I know, Yiduli is a high-incidence area for liver fasciola due to the development of animal husbandry. You eat cress, the aquatic food there, and you are very susceptible to liver flukes. Your repeated abdominal pain attacks and blood eosinophilia should be directly related to parasites!"

"So what should I do?"

"It's simple, go and take a blood test!"

Lin Feng opened a blood drawing list and sent it to the pathology department for examination.

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ps: This is the last chapter, today it is estimated at more than 30,000 words... Subscribe, keep coming!

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