Since 1981 Health School

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 major medical record that had just been written 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 also 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, so tell me what is the basis of 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."

Dean Guo smiled and said nothing. Instead, he handed the medical records to Qi Damin who was next to him, and motioned 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.

"Dean 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 records, the first thing he saw was the beautiful pen writing, which was strong and powerful, which made him nod in his heart.

The entire serious medical record was written down in more detail than Zhang Jun's, but if you really had to score it, the scores of the two were 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 express his opinion, he directly turned to the diagnosis page, 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 immediately 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 not destined 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."

Dean 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."

Dean Guo handed over two pieces of paper,

One was a B-ultrasound contrast report, which indicated that the lumen at the bifurcation of the left and right hepatic ducts was narrowed, and a lump measuring 2.7cm*1.4cm could be seen in the common hepatic duct after contrast medium injection.

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

After Zhang Jun read it, he looked even more proud, feeling that his diagnosis was stable.

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

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

"How about it, after the two students read these two reports, do you need to revise your initial diagnosis?"

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."

Dean 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 a malignant tumor is the greatest."

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

Dean 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 several reports and the medical 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 stated the basis of his diagnosis in detail, he didn't offer support.

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

Dean 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 patient’s clinical manifestations did not match. He did not have jaundice. Neither the results of the laboratory tests nor his own complexion suggested jaundice. In addition, the patient did not have 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.

We are all professional doctors. Although we have inclinations in our hearts, we also understand the truth that if you listen, you will understand.

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 leader.

Regardless of everyone's thoughts, Chen Qi followed his own train of thought and continued:

"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.

Another basis 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 ponder.