This doctor has a system

Chapter 519 582. Replace the bracket
"The current situation is that the stent cannot be removed at all. She has to do a bronchoscopy every once in a while to clean out the contents inside." The patient's son said to Gao Feng. He also looked very tired. The ordeal of more than a year was really too much for this man in his prime.

One day ago, Zhang Meiniu developed chest tightness after coughing. After oxygen inhalation did not relieve the symptoms, she came to the hospital again.

The doctor suspected that the stent had shifted, but after using a bronchoscope, he found nothing.

The doctors at the First Affiliated Hospital were also helpless. They tried all kinds of treatments, but there was no effect.
Just when I was feeling discouraged, a director said: Why not let the patient go see Professor Gao from the Provincial Hospital?
"Be hospitalized first and do a bronchoscopy after a complete examination." Gao Feng wrote out a hospitalization certificate promptly.

Hearing his calm voice, Zhang Meiniu's son's originally anxious mood inexplicably calmed down.

I hope this doctor can do it, he prayed in his heart.

After the afternoon outpatient clinic ended, Gao Feng returned to the general practice ward, where several doctors were conducting evening rounds.

According to regulations, resident doctors need to make ward rounds twice a day, morning and evening, but this can usually only be done in large hospitals because there are so many people.

Grassroots hospitals cannot support so many people, and many systems are in name only. After all, some doctors are off night shift, and you can't call them over at night to check on them again.

Another thing is that compared with large hospitals, the conditions of patients in grassroots hospitals are not that complicated.

"Mao Wen, does the middle-aged man I took in have liver problems?"

"Yes, he has liver cirrhosis, and the color Doppler ultrasound shows that the patient has a small amount of ascites." Mao Wen quickly replied, "Both liver enzymes and bilirubin are significantly elevated. Oh, and there are some heart problems, too. I asked him to wear a 24-hour dynamic electrocardiogram."

The patient drinks heavily all year round, so he should have alcoholic cirrhosis. The ascites indicates that the situation is not very good, at least at stage III.

The liver is the largest digestive organ in the human body. Gao Feng is a graduate student majoring in gastroenterology, so he is naturally familiar with this disease.

Cirrhosis of the liver is a very common disease in my country. It is a diffuse proliferation of liver fibrous tissue based on extensive necrosis of liver cells, forming nodules and pseudolobules, which in turn destroys the normal structure and blood supply of the liver.

According to the cause of the disease, cirrhosis can be divided into viral cirrhosis, cholestatic cirrhosis, alcoholic cirrhosis, cirrhosis caused by autoimmune liver disease, congestive cirrhosis and cryptogenic cirrhosis.

When Gao Feng arrived at the ward, only the patient and his wife were there, and his son had gone downstairs to buy dinner.

"Then you can give me some medicine to make it softer, right?" the patient said. "How? Is it difficult?"

"Uncle, what is your educational background?" Li Youliang asked.

"What do you care about my education?" The uncle was a little unhappy. "What's wrong? You don't want to see me because I have a low education?"

"I won't give you a penny less!"

"Doctor, he didn't even finish elementary school. Tell me what you have to say." The patient's wife said, "I have a high level of education. I graduated from junior high school."

"Why don't we wait until the child comes back and talk about it together?

Gao Feng and Li Youliang returned to the office first. He wanted to take another look at the film of the patient with tracheal stenosis.

After about 20 minutes, the uncle's son came over.

"Doctor, is there something you have to tell me?" He was very nervous. "My father doesn't have cancer, does he?" "It hasn't gotten to that stage yet." Gao Feng signaled him not to be overly nervous. "Your father should have alcoholic cirrhosis, and currently has ascites, which is quite serious."

Hearing that the patient has reached the stage of liver cirrhosis, the patient's son is a little anxious.

He said that his father had been drinking since he could remember. He would drink with guests when there were guests, and drink alone at home when there were no guests. He was a pure drunkard.

"I told him to stop drinking a long time ago, but he didn't listen!" The patient's son was angry and helpless. "You have to emphasize this to him. One word from you doctors is worth 10 words from us."

That being said, it actually depends on the patient himself. The patient himself cannot be unaware of the damage caused by long-term heavy drinking.

However, many people only regret their decisions at the last moment.

This is what it means to not cry until you see the coffin.

Zhang Meiniu, who suffers from tracheal stenosis, lives in a single room with 8 beds. In her condition, she needs at least two caregivers.

Mao Wen prescribed some cough suppressants for her. Now her cough is not as severe. When Gao Feng went in, she was half lying on the bed and sleeping.

Zhang Meiniu's son had just gone to the endoscopy room for an appointment for a bronchoscopy. The doctor there wanted to talk to him about the risks, but he said a few perfunctory words and quickly signed the informed consent form.

"Director Gao, is there still hope for my mother?" he asked. "I feel like she won't be able to leave the hospital for the rest of her life."

It was fine some time ago, but these few times I can't stay at home for more than a few days. Either the phlegm is blocked, or I suddenly have a violent cough, and my lungs seem to be coming out.

The whole family was exhausted.

Some doctors suggested cutting the tube directly, but no one can guarantee whether other conditions will arise later.

What a dilemma.

Sometimes when seeing his mother in pain, Zhang Meiniu’s son even had a bad idea: how about this?
"Let's give it a try." Gao Feng said to him, "I think it should be fine, but we have to see the actual results."

Zhang Meiniu currently has a self-expanding covered metal stent placed. The advantages of this stent are that it is easier to remove and replace than a bare metal stent, it prevents granulation tissue from growing into the cavity through the stent mesh, it has a higher inner-outer diameter ratio, and more distal airway lesions can also be treated.

However, this type of stent also has obvious disadvantages, namely, secretions block the flow, granulation tissue grows at both ends of the stent, the incidence of stent displacement is lower than that of silicone stents, but higher than that of bare stents, radial force can cause mucosal necrosis and fistula formation, and excessive exogenous pressure can cause stent collapse.

Gao Feng felt that the previous placement of this type of stent was very appropriate for the patient, but now that the hyperplastic tissue in the trachea has been almost cleared, it may be considered to replace it with a silicone stent.

Compared with self-expanding covered metal stents, silicone stents have good tissue compatibility, are not easy to stimulate granulation tissue proliferation, are easy to remove or replace, and can also resist exogenous compression to a certain extent.

However, its disadvantages are also obvious. It needs to be placed under general anesthesia and rigid bronchoscope. The stent wall is thick, the lumen is relatively small, the airway resistance is increased, it is easy to shift, secretions block the flow, hinder ciliary movement, and it is not suitable for irregular airways.

However, Gao Feng believes that there are ways to solve these shortcomings.

The most important thing at present is to reduce stimulation to the trachea and avoid hyperplasia of granulation tissue. Otherwise, the patient will be hospitalized repeatedly and the quality of life will be very poor.

(End of this chapter)