The system takes me for surgery

A fair-looking boy wearing glasses said: "Will there be brain metastases from digestive system tumors? Many middle-aged and elderly patients in the gastroenterology department often have recent loss of appetite, weight loss, and vomiting after meals. Be vigilant against gastric cancer. Normal, endoscopic examination should still be performed."

Xie Tianmu nodded and said, "It looks a bit reliable, Ai Zhu, what do you think?"

Tan Aizhu said: "Although the patient has bilateral temporal pain, the headache is mild and intermittent, the vomiting is non-projectile, the physical examination shows no signs of meningeal irritation, no signs of nervous system positioning, and the head CT of the outer hospital shows no abnormalities, all of which are not supported. A head CT scan can be repeated, and a lumbar puncture can be performed."

Director Li Zhengping smiled and said, "Liang Yi, what do you think?"

Liang Yi was still thinking, when he was asked a question suddenly, he was taken aback for a moment, and said, "Almost, let's do a brain CT
Then please ophthalmology, ENT consultation. "

The diagnosis of gastric cancer metastasis was left to be determined.

After admission, Tan Aizhu performed other auxiliary examinations on the patient, and there was nothing abnormal.

When she went to the ward, although the patient's daughter-in-law could not speak Mandarin, she already had some emotions about her husband still vomiting.

The patient said: "Doctor, we rural people can't afford to spend so much money for examinations, why don't you just prescribe me medicine?"

Tan Aizhu explained helplessly: "It's because we can't make a diagnosis, so we need to check one by one. If the diagnosis is confirmed, we will definitely prescribe medicine for you. You also know that medicine should not be taken indiscriminately."

"I know, I know, but every checkup is one or two thousand yuan. How can we afford it in our financial situation? The 2000 yuan that I paid this morning is gone immediately, and the nurse is urging to pay again." Patient Said.

"I will try my best to help you control the cost, but the inspection still needs to be checked."

"Thank you doctor," said the patient.

His daughter-in-law who can't speak Mandarin also parroted and thanked Tan Aizhu.

Tan Aizhu returned to the doctor's office and said to Liang Yi: "Hey, it's too difficult to be a doctor now. Not only do you have to see a doctor, but you also have to help patients settle accounts. This family member already has an opinion on the current fees."

Liang Yi asked: "It's inevitable that there will be opinions. After all, patients can only pay for the medicine, and the inspection will fool them with money."

"Yes, that's what he meant."

"It will be even more difficult to prescribe him other tests in the future."

"Now I don't dare to open the inspection."

"How about the consultation at the ophthalmology department?"

"Their diagnosis, the visual field of both eyes is concentrically narrowed, and the optic disc edema is ignored, which is meaningless."

Liang Yi looked at the patient's medical records repeatedly, and drew a red circle on his draft paper with a red pen.

He said: "Sister Tan, it's a bit strange that this hospital was discharged after being treated with sodium supplementation."

Tan Aizhu said: "What's so strange? There is low sodium, so treat it symptomatically."

Liang Yi continued: "There is nothing wrong with them doing this, but the patient has intermittent nausea and vomiting, the course of the disease is longer, and the amount of vomiting is not large. Logically speaking, it should not constitute the patient's hyponatremia and hypochloremia."

This logic is a bit convoluted, and Tan Aizhu didn't realize it.

Liang Yi took out a dark blue pen and explained: "There are three common causes of hyponatremia. The first is insufficient intake. Patients eat poorly, but insufficient intake often only leads to mild hyponatremia. Can cause severe hyposodium."

Tan Aizhu nodded and said: "That's right, it can also be caused by dilutional hyponatremia. Due to excessive fluid, sodium is relatively insufficient and extracellular volume is low, but the patient did not drink significantly, and the intake and output were relatively balanced. However, this patient This diagnosis is also not supported.

"Well...these two are impossible, so there is only one situation." Liang Yi continued to write with a black ink pen, and said: "There is too much sodium loss, but there is a strange phenomenon. The test results show that the patient loses sodium through the kidneys significantly. , but there is no acidosis, and it does not support renal tubular lesions, which excludes hypofunction of the adrenal cortex from surgery. Moreover, your patient has no skin pigmentation, low blood pressure, hyperkalemia, etc. Abdominal CT shows no adrenal gland abnormalities, combined with The patient has recently experienced vision and hearing loss, and intermittent headaches, and I think the hypofunction of the adrenal cortex may be secondary, and the lesion may be located in the pituitary gland or hypothalamus."

After saying this, Tan Aizhu felt a little enlightened, and said, "It's really possible. I always thought about the digestive system and the adrenal cortex. Why didn't I think about the pituitary gland and hypothalamus."

Tan Aizhu immediately stood up and said, "I'll ask the doctor again."

"I'll go with you." Liang Yi said.

"it is good."

They came to the ward together.

Tan Aizhu questioned the patient's medical history and found that the patient had recently experienced chills, swollen hands and feet, and sexual dysfunction.

In the past, she thought that in the modern medical environment, consultations were unnecessary, but this case made her realize that if she made detailed consultations, she might be able to reduce some unnecessary examinations for patients.

Liang Yi said: "The brain CT can't show anything, so I need to do a brain MRI."

Tan Aizhu nodded and said, "I have to do one, but the family members and patients don't agree to spend money on the examination. It's quite troublesome. I'll talk to the family members again."

She communicated back and forth with the patient for more than half an hour, and asked the patient to tell his daughter-in-law. Liang Yi found that Tan Aizhu's attitude towards the patient had changed, and he became calm.

In the past, if encountering such a situation, Tan Aizhu would definitely say "this is your disease, do you like to do it or not."

Now she will patiently explain to patients and family members the necessity of all examinations repeatedly. Although the head MRI is expensive, there are many things that can be seen.

Liang Yi saw Tan Aizhu's empathy. He originally thought she was an extremely indifferent person, but he didn't expect her to have such an empathetic side.

Empathy is the ability to experience other people's situation by empathizing with others, so as to feel and understand other people's emotions. This is a must for a doctor. If a doctor does not have the ability to empathize, then all patients are just leeks for him to realize. This kind of person should trade stocks professionally, and should not practice medicine.

After Tan Aizhu's patient explanation, the patient and his family members finally agreed to do a head MRI.

One hour later, the head MRI results came out, the sella was enlarged, and a large abnormal signal shadow was seen in the sellar area, with a clear boundary and a range of about 0.56cm x0.5cm x1.14cm. The lesion protruded upward into the suprasellar cistern, and the optic chiasm was compressed Elevated, the left cavernous sinus is involved; the posterior pituitary is short because the signal is compressed and moved up; enhanced MRI: the abnormal signal focus in the sellar area is slightly enhanced.

Liang Yi's judgment was correct. These were the direct and secondary manifestations of the symptoms caused by the brain tumor.