Chapter 604

595 Have you memorized the manual?

"Director Xia, I'm back." Zheng Ren knocked and entered; Director Xia was studying the double gallbladder anomaly.

"Chief Zheng, come explain the double gallbladder anomaly to me." Director Xia didn't stand on ceremony, waving her hand candidly.

She tried to stand up to give Zheng Ren her seat, but Zheng Ren laughed and pressed her down into the chair.

"Director Xia, I wouldn't dare. Please sit, sit, it's not hard; I'll just say a couple of things." Zheng Ren bent over, right hand gripping the mouse, began moving the MR 3D reconstruction he had just made.

Both nuclear magnetic resonance and CT can do 3D reconstruction, but clinical doctors basically only know CT 3D reconstruction; few know that nuclear magnetic resonance can also do reconstruction.

CT resolution can reach 0.5mm, but the nuclear magnetic resonance at Haicheng Shi Yiyuan, although 3.0 tesla, has a resolution of only 6.0mm, making the 3D reconstruction look like it's been mosaicked, which feels awkward.

Zheng Ren was simply trying to save trouble, and also to save the patient some money.

The gold standard for diagnosing double gallbladder anomaly is ERCP, but because ERCP is an invasive examination and costly, the current consensus is to use MRCP for examination to confirm diagnosis.

As for 3D imaging, Zheng Ren just did it casually, to avoid bothering the patient and to avoid uncertainty; Director Xia found this difficult to do.

Although Director Xia didn't intentionally misdiagnose... basically no one would intentionally misdiagnose, and the patient seemed cooperative, but Zheng Ren subconsciously eliminated all potential risks at the bud.

Director Xia, look here, the patient's double gallbladder both have cystic ducts." Zheng Ren used the mouse to trace out the area he wanted to talk about, then briefly explained: "Double gallbladder malformation is divided into type 1 and type 2. Harlaftis type 2 refers to double gallbladder with two or more cystic ducts independently connecting to the common bile duct; type 2 can be further subdivided into H-shaped variant and trabecular variant.

"This patient belongs to the relatively common Harlaftis type 2, which means it can be treated surgically."

"The patient currently has no pain symptoms; I estimate the likelihood of the patient's family agreeing to surgery is low. However, you can tell the patient and their family that I can perform this surgery."

Director Xia glanced at Zheng Ren, lightly and indifferently, without surprise, and said nothing.

"In 1997, Gigot reported a case of double gallbladder malformation. At the time, the surgeon removed only one gallbladder, leaving the other. Twenty‑seven months post‑operatively, the remaining gallbladder developed gallstones and acute cholecystitis, leaving no choice but to remove it as well."

"If surgery is performed, I recommend removing both gallbladders."

"Of course, this is just my opinion. I think the patient should still seek a few more opinions." Zheng Ren hesitated slightly, wanted to say something, but finally held back.

"Chief Zheng, you young hotshot have really slapped me down on the beach." Director Xia sighed.

"You say that." Zheng Ren laughed: "No way."

Director Xia picked up the Rocephin (ceftriaxone) package insert from the table, waved it, and said: "Chief Zheng, you can memorize the package insert—this skill… I can't."

Zheng Ren smiled and said nothing.

"Chief Zheng, how do you know this?" Actually, Director Xia also didn't believe Zheng Ren could memorize the drug's package insert.

Commonly used clinical drugs number at least a hundred.

The better the drug, the more detailed its side‑effects are written.

If you look at the package insert, this drug basically cannot be used.

But the better the drug, the better its effect. Unlike the junk produced by fly‑by‑night drug factories, whose inserts claim to cure almost everything.

So, to Director Xia, Zheng Ren's knowledge of this is quite strange.

Just how good does his memory have to be?

"Director Xia, my medical license is in general surgery." Zheng Ren said: "A Few Years Ago, did you hear about the medical accident at Liao Zhou People's Hospital?"

Liao Zhou is a county under Hai Cheng; a few years ago they performed a gallbladder removal surgery on a patient diagnosed with cholecystitis and gallstones.

Coincidentally, the patient's family insisted on seeing the stones, saying they were relics and wanted to keep them as a memento.

Before the operation, they also slipped in a red envelope, and the lead surgeon confidently said he would definitely keep the stones for the family. However, it was just a gallbladder removal, and no one thought there would be any risk.

But after removing the gallbladder, the lead surgeon was an idiot.

There were no stones in the gallbladder at all.

The incident blew up. The lead surgeon insisted that the pre‑op ultrasound showed gallstones and that his surgery was fine, but after the operation no stones were produced, and he refused to back down.

Finally, the family hung banners, and the situation grew larger.

Later, the lead surgeon was suspended, and the hospital had to pay a large sum.

Zheng Ren firmly refused to accept red envelopes, which is directly related to this incident.

Just thinking about it is frightening. The pre‑op auxiliary tests were quite certain there were stones, only they weren't large.

But during the operation, the stones vanished like a ghost.

When faced with this situation, how should one explain it to the patient's family? If no money was taken, one could still be firm; but if money was taken, there would be nowhere to hide.

After this incident, Zheng Ren read a lot of materials and mastered the antecedents and consequences of this gallstone condition even before the Big Pig Trotter incident.

Therefore, when encountering this today, he directly judged it to be crystalline substances left from gallbladder metabolism due to intravenous ceftriaxone, and stopping the drip would make them disappear soon.

To Zheng Ren it's a minor matter, but to Director Xia it seems miraculous.

Director Xia thought of that medical dispute and immediately realized that the lead surgeon at the time had also encountered this kind of situation.

Without Zheng Ren, if I ran into another difficult family member, I would have no way to explain how gallstones form.

Fortunately, I seem to have good luck, having met this young Chief Zheng.

For doctors doing clinical work, luck is very important.

Director Xia nodded, understanding Zheng Ren's meaning. Zheng Ren didn't say anything more, after all, when a rabbit dies, the fox grieves; creatures feel sorrow for their own kind.

Speaking ill of that lead surgeon behind his back would make both Zheng Ren and Director Xia feel a bit awkward.

After chatting a few more sentences, Director Xia felt reassured, and Zheng Ren then said his goodbyes and left.

Can Shou Bing be performed?

Of course it can be done.

But Zheng Ren knows that for this rare disease, it would probably be difficult for the family to choose to have the Shou Bing done in Hai Cheng. Zheng Ren can only provide his opinion to Director Xia, who will then explain it to the patient's family.

The size of a temple and the incense offered to the bodhisattva are directly related.

Moreover, I belong to the type that is too young, making it hard for the patient's family to feel trust.

If it were changed to Di Du or Modu, Zheng Ren could probably just explain the situation directly to the patient's family and perform the Shou Bing.

Zheng Ren still has a fairly clear idea of this point.

No Rush, Zheng Ren leisurely returned to the Jizhenbingfang, looked over the patients, and then continued sitting down to read.