Chen Xia introduced, "You're in luck. This is Dr. Barry Marshall from Australia. He's temporarily visiting our hospital to conduct research. If you feel unwell, please tell us right away."
Qiu Yuxing looked at him deeply, lowered his head and took the emergency medical record.
Chen Xia flipped through the patient's emergency records as quickly as possible and began to memorize them.
Qiu Yuxing's mother kept urging, "Doctor, hurry up! My husband's condition is getting worse."
Chen Xia quickly translated:
"Dr. Barry, here's the situation. A 45-year-old patient was admitted to the hospital with sudden abdominal pain an hour later. An electrocardiogram in the emergency department showed sinus tachycardia. Amylase was significantly elevated, exceeding five times the normal value.
A blood test revealed an elevated white blood cell count. Vital signs were normal, with the exception of a rapid heart rate and high blood pressure, but the temperature and respiratory rate were normal. Emergency doctors suspected acute pancreatitis.
Although Chen Xia's spoken English was not very fluent, there was no problem with basic translation. Even the young doctors behind him were stunned by what he said.
"Si Gao Yi", Mr. Chen is really amazing.
Qiu Yuxing was completely confused. This old lover brought her more and more surprises. She had never seen how good his English was when he was in school. Now he could even do translation?
Regret, she really regretted it so much.
After listening to the introduction, Dr. Barry Marshall immediately began to conduct a thorough physical examination on the patient. Even Mr. Qiu was stunned for a moment and forgot to cry out in pain. It felt so strange to be touched in the stomach and listened to the stethoscope by this foreign doctor.
Chen Xia was still explaining while looking at the emergency medical records:
"The electrocardiogram ruled out myocardial infarction, and the emergency doctor suspected acute pancreatitis. The reason was that the patient had a history of heavy drinking the previous night, drinking a pound of white wine. The most important thing was the significantly elevated amylase and white blood cell levels."
At this time, Dr. Barry Marshall's palpation of the abdomen just reached the upper and middle abdomen, where there was obvious tenderness and rebound pain, which indirectly supported the diagnosis of pancreatitis.
After he finished the examination, he stood up straight and said to the many young doctors around him:
"Through palpation, the patient's upper abdominal muscles were tense and there was tenderness and rebound tenderness, which indicated a positive peritoneal irritation sign. In addition, the patient had a fast heart rate and high blood pressure. Two diagnoses should be ruled out, namely gastrointestinal perforation and thoracic and abdominal aortic dissection.
Clinically, although a significant increase in amylase often indicates acute pancreatitis, pancreatitis is not the only disease that can cause an increase in amylase. Many diseases related to acute abdomen may also cause an increase in amylase.
The gold standard for diagnosing pancreatitis, especially distinguishing mild from severe cases, is a pancreatic enhanced CT scan. Therefore, I believe this patient needs further testing; it's too early to make a diagnosis. Without a definitive diagnosis, different diseases require completely different treatments.
As soon as these words were spoken, many young doctors nodded and hurriedly lowered their heads to take notes. Even Chen Chun was thinking about what he should do if he were the attending physician.
Seeing that everyone was thinking, Dr. Barry Marshall smiled and said:
"Perhaps you can use your own experience to speculate on the most likely cause of the patient's illness. Make bold assumptions and carefully verify them. We doctors must not limit our thinking."
Seeing everyone eager to try, wanting to speak but not daring to, Chen Xia took the lead and offered a hypothesis, "I think digestive tract perforation and peptic ulcer are still possible."
"OK, anything else?"
Huang Xiaoping then replied: "Ectopic appendicitis, cholecystitis is also possible."
“That’s a very different answer, very good.”
Everyone laughed. It was quite interesting to hear foreign doctors making ward rounds. If they were doing ward rounds with the director, there was no way it would end without being scolded.
Another junior doctor suggested: "Lung and pleural lesions cannot be ruled out."
Dr. Barry Marshall nodded:
"It seems that Chinese doctors have a good grasp of the basics. So, how should we rule out a clear diagnosis next? In our country, the best way is to do a CT scan and gastroscopy, which can rule out most diseases. Unfortunately..."
Chen Xia laughed when he heard this: "Dr. Barry Marshall, you underestimate us. Our hospital has a CT machine and a gastroscope, and they are all the latest models."
"Really? That's great! I apologize for my shallowness. Now, let's arrange for the patient to be examined immediately. This time, I will perform the operation myself.
In Australia, doctors not only need to be able to diagnose patients, but also need to be able to operate various auxiliary examination instruments. We prefer to trust our own clinical thinking and can discover many details that other doctors cannot see.
This is the difference between the regular training of doctors in China and abroad. China pays more attention to clinical practice, while foreign countries pay more attention to the comprehensive development of doctors, emphasizing the level of a specialist and the overall view of a general practitioner.
Just like Section Chief Chen Xia, he is now a surgeon doing the work of an internist, even though he is forced to do so. But if it happens a few decades later, he will definitely be practicing medicine beyond the scope of his registered practice, and he will be able to catch anyone wrong.
After everyone finished their discussion, Chen Xia said to Qiu Yuxing, "We'll start writing a checkup order right away. You should take your father for some tests right away. Don't worry, we're here to make sure nothing happens to him."
Qiu Yuxing bit her lower lip and nodded slightly.
Mother Qiu kept expressing her gratitude, but she had no idea how the couple had advised their daughter to recognize the situation and stay away from a certain country bumpkin when Chen Xia's family got into trouble.
By the time Mr. Qiu was wheeled into the CT room, Dr. Barry Marshall and many other doctors had already crowded into the operating room behind the radiation-proof glass window. Even Luo Wei and Shi Zhixian in the CT room looked at the foreign doctor curiously.
Watching his skillful operation and careful reading of the film, everyone realized what a versatile person is. The gap between us is still too big, and we must continue to learn in the future.
An abdominal CT scan ruled out gastrointestinal perforation, and there was no appendicitis, cholecystitis, abdominal aortic dissection, or even acute pancreatitis. The CT scan showed no exudation around the pancreas, but there was thickening of the gastric antrum wall.
So, was the patient suffering from peptic ulcer? To confirm the diagnosis, a gastroscopy was performed, and the results showed congestion and edema of the gastric antrum mucosa, suggesting gastritis rather than ulcer.
Could it be a chest disease? Further divergence of thought suggests that a patient with pleurisy might present with abdominal pain. However, a chest CT scan ruled out lung and pleural lesions, and there was no evidence of thoracic aortic dissection.
Dr. Barry Marshall's operation was as fierce as a tiger, which also stunned the young doctors. They didn't know that medical treatment could be so advanced now, and doctors could do everything.
In the past, without CT and gastroscopy, this type of acute abdomen would result in either death or laparotomy, with serious consequences.
This shows how wise it was for Chen Xia to buy the CT scan.
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