At 2 a.m., the urgent ringing of the mobile phone rang. In my sleep, I answered the phone dimly, it was a call from the nurse on duty: emergency department emergency consultation!
Rubbing my sleepy eyes, I was awakened by the cool breeze of the spring rainy night, put on my white coat, and went straight to the emergency department.
It's an ordinary duty day, and since it's a weekend, it's not too busy during the day. I also remembered who had said not to eat mangoes on duty days, or it would be very busy. I just ate mangoes today, thinking in my heart, I wasn't too busy...
Although I can lie in the duty room on duty days, I actually sleep not too deeply, so when the nurse called in, I was not shocked, but answered the phone smoothly and quietly.
The nurse told me that the emergency department considered a liver occupancy and that abdominal pain required consultation. I wondered along the way, liver placeholder abdominal pain, either liver cancer is too big, or liver abscess, should it be trauma, right?
Thinking, walking quickly, I came to the emergency department in a short while.
The emergency department doctor told me that the patient was suffering from pain in the right side of the waist, and at first he also considered whether it was renal colic, checked the upper abdomen CT scan, and found that there was a huge place in the right lobe of the liver.
I opened the CT and looked at it, and it was indeed a huge placeholder on the right lobe of the liver, which looked bigger than my fist, and the report said about 10x9.7x9.5CM.
From my many years of clinical experience, eight or nine is liver cancer.
I asked my colleagues in the emergency department, what do you think? He said: I considered liver cancer, and I talked to the family about it, and the family said not to let the patient know first.
I heard that it is liver cancer, and the patient's family members tell the doctor not to let the patient know. This plot is often staged, and it has some Chinese characteristics.
Whether young or old, families always have a reason. "He's still young, I'm afraid he can't stand it." "He's old, I'm afraid he can't stand it."
It is under this concept that many cancer patients do not have the right to know their own condition. Some receive treatment under the "concealment" of their families, or give up treatment.
Someone said that doctor you wouldn't tell the patient? The doctor wants to tell the patient, but the doctor is "morally kidnapped", in case the patient can't think... Tell you not to tell the patient....
In fact, this situation is because many people do not have a scientific view of disease and a correct view of life. Of course, this is also related to doctors, doctors should do more science popularization, enlighten the people's wisdom.
A person with independent ability to act has the primary right to know about his or her condition. I hope that the younger generation will be able to firmly establish this concept. At any time, you have the right to decide whether or not you receive treatment.
I went to check on the patient, and the first thing that caught my attention was his face. A 45-year-old middle-aged man with a dark face and a brown cyanosis lip, which is often said in books, liver disease.
He said that he was more than 9 o'clock in the evening, and when he was ready to go to bed, he suddenly had a sharp pain in his right waist. I couldn't help but go to the hospital accompanied by my family.
On palpation of the abdomen, the most pronounced tenderness is in the right upper abdomen near the waist, and there is percussion pain in the liver area. Because painkillers have been used after the emergency department, the pain has been significantly relieved.
Asked if the patient has a history of hepatitis B, whether there is a history of trauma, whether there is diabetes, all said no. These questions are very necessary and logical, corresponding to my previous conjecture: liver mass abdominal pain, liver cancer caused by hepatitis B? Liver damage caused by trauma? Liver abscess caused by diabetes?
At the request of the family, I called the family aside, synthesized the medical history, symptoms, signs, and auxiliary examinations, and analyzed my judgment.
The patient is from a rural area, has been working outside the home for a long time, has not done a physical examination, and does not know whether he has hepatitis B. However, from the perspective of the face, it is very consistent with the performance of the liver disease face, and it cannot be ruled out that there is hepatitis B.
It was learned from the patient's brother that the patient's brother had been diagnosed with hepatitis B. It is very likely that the brothers were infected by the mother-infant route of hepatitis B, that is, their mother is also likely to be a carrier of the hepatitis B virus.
However, because it is a rural family, the family members have not done a physical examination, so they have not learned whether there is hepatitis B infection.
From the CT scan, it is consistent with the manifestations of giant liver cancer in the right lobe of the liver. Because the lump is so large that it clings to the circumference of the liver and squeezes into the peritoneum of the ribs of the right diaphragm, it causes pain in the right upper abdomen (near the right waist). It may also be severe pain caused by intratumoral hemorrhage stimulation.
The patient heard my analysis and was momentarily incredulous.
I talked to them about hepatitis B, cirrhosis, and liver cancer.
The mainland is a big country with hepatitis B, and hepatitis B is one of the main causes of cirrhosis and liver cancer. The main transmission routes of hepatitis B include: 1. Mother-to-child transmission, that is, mothers infect newborns through the birth canal in the process of giving birth to children.
2. Blood transmission, which may cause blood transmission, is the behavior of blood transfusion, blood sales, drug use sharing needles, ear piercings, eyebrow tattoos, tattoos, etc. that may lead to blood exchange.
3, sexual transmission, which is why hepatitis B is considered a sexually transmitted disease (STD).
If hepatitis B infection is detected, it is recommended that your mother, children, and partners have a two-and-a-half test for hepatitis B to see if they are infected with hepatitis B.
Infection with hepatitis B virus may be carried by hepatitis B virus, or damage to liver cells may occur to form chronic hepatitis B virus. Whether it is carried by hepatitis B virus or chronic hepatitis B, regular physical examinations are required, because both may progress to cirrhosis or liver cancer.
I give my advice to further refine the following checks:
Hepatitis B two-and-a-half, hepatitis B virus DNA, abnormal prothrombin (PIVKA-), alpha-fetoprotein, liver-enhanced CT, liver-enhanced magnetic resonance (disodium gadostate as contrast agent), ultrasonic contrast, etc.
After the diagnosis of liver cancer is confirmed, surgical resection is preferred for evaluation of those that can be surgically removed.
It's an ordinary duty day, and the same plot is constantly playing out.
Hepatitis B may be cleared in the near future, and I, as a hepatobiliary surgeon, can also do the same as that sentence: I would rather have a knife in my hand, but I hope there is no liver cancer in the world.
Follow-up: After examination, the patient was diagnosed with hepatitis B and liver cancer, and recovered well after surgery.
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This article is original by [Dr. Luo Health Said], the author is a member of the Chinese Anti-Cancer Association, a member of the Health Communication Working Committee of the Chinese Medical Doctor Association, a health science writer, welcome to forward, comment, like, or private message with me, thank you very much!