Chapter 531: Touching the neck can identify venous and arterial lesions and tissue necrosis stage

Author: Jiangbian Yuweng

Chapter 531: Touching the neck can identify venous and arterial lesions and tissue necrosis stage

"I heard that you cured a disease that even the top hospitals in the imperial capital couldn't cure. We came here specially to see you this time." The son of the veteran cadre also said beside him.

These people are well-informed and can naturally learn about Zhou Can's legendary story from some channels.

Especially for such a powerful family, those who want to flatter them will try their best to find world-famous doctors for them.

"Thank you for your trust and love, but I am not that powerful. I am just an ordinary doctor. Let me check your body first!"

Zhou Can is not used to being praised by others.

He is a more down-to-earth person and likes to concentrate on studying medicine or treating patients.

The patient's biochemical test results, urine routine, and stool routine were all normal.

Because the patient had pain in his lower limbs, blackened toes, and gangrene. He was worried about kidney function problems, such as uremia, so he specifically performed a kidney function test on the patient.

The patient's renal function was found to be normal.

Later, I was worried that the patient had diabetes, so I checked my fasting blood sugar, which was still normal.

Even liver function problems were suspected.

Unfortunately, after checking the liver function, it was still normal.

Diabetes, uremia, and hepatitis, which are likely to cause gangrene in the lower limbs, have basically been ruled out.

The diagnosis has basically reached a deadlock here.

It was with this in mind that Zhou Can asked to come over to see the patient's actual condition. The physical examination is a general examination. It seems that everyone's examination content is similar. In fact, a high-level doctor can find many clues from the physical examination.

It is of great help in diagnosis.

It’s perfectly fine to at least provide some direction for thinking.

The patient himself and his family members were very cooperative and very willing to let him help with the physical examination.

He first opened the quilt and looked at the patient's right foot.

Some disinfection and other treatments have been done above, mainly to prevent local necrosis of the foot from causing severe rot and further infection.

Gangrene refers to special morphological changes such as necrosis and blackening of local tissues.

It is mostly caused by blood circulation disorders caused by disease, trauma and other factors.

Causes large-scale ischemia and necrosis of local tissues, and secondary infection by putrefactive bacteria.

Gangrene can be divided into dry and wet types. Dry gangrene presents symptoms such as blackening, dryness, and necrosis of the limbs. Wet gangrene does not secrete, and causes pus to rupture, rot and smell.

Overall, dry gangrene is slightly better.

However, this is not absolute.

For some patients, wet gangrene looks very scary, but it may be easier to treat.

The main thing is to find the cause of the disease, improve local blood supply, fight infection, etc.

Through observation, Zhou Can found that the fourth toe of the patient's right foot had turned black and was serious. There was obvious gangrene.

And there is no obvious junction with normal tissue.

This means that gangrene can continue to progress and spread upward.

No wonder the doctors in the first few hospitals said they wanted to amputate the limb to save his life.

After Zhou Can looked at it, he began to examine the patient's neck.

Because of lower limb pain and gangrene, after ruling out common causes such as diabetes and uremia, there are basically only two possibilities left. Either bacterial and viral infection, or blood vessel problems.

The patient received anti-infective treatment in the first two hospitals, but the effect was not obvious.

It also failed to prevent the progression of the disease.

This means that viral or bacterial infection is less likely.

Moreover, the patient's biochemical tests are basically normal. There are no problems with liver and kidney functions, but blood vessel problems are most likely.

The most common problem in the lower limbs is the veins.

If you are injured in a car accident or the like, you need to be particularly vigilant about damage to the femoral artery. Especially crush injuries can easily cause the femoral artery to rupture and cause massive bleeding.

This veteran cadre is obviously more consistent with venous lesions.

Zhou Can didn't touch the patient's right foot, but touched the patient's neck. What's going on?

First of all, some of the veins in the lower limbs are deep veins that cannot be touched or seen. When he just observed the patient's right foot, he had already checked the superficial veins on the patient's right foot.

No obvious abnormalities were found.

So I went straight to the largest vein that can be felt on the body surface, the jugular vein.

The origin of human blood is the heart, whether it is arteries or veins, they all originate from the heart.

However, when doctors examine patients, they cannot cut open the patient's chest to check whether the veins are normal. The most common and effective way is to feel the jugular vein.

Of course, this requires doctors to have extensive diagnostic experience.

Through palpation, Zhou Can found no distension of the patient's jugular veins and no abnormal pulsation of the carotid arteries. The trachea was in the middle and there were no abnormalities either.

Neither the cervical lymph nodes nor the thyroid gland were enlarged.

There was no cervical stiffness or the like in the neck.

After checking the neck, he put on a stethoscope and began to examine the patient's chest and abdomen.

According to naked eye observation, the patient's chest and respiratory movements are symmetrical and normal. The bilateral tremors are symmetrical, and the breath sounds in both lungs are slightly thick, which is considered normal. It is possible that the patient was a little nervous when he was being examined.

He heard mild crackles in the patient's right lower lung.

Sometimes not.

This was a new discovery. Zhou Can's expression moved slightly, and he continued to examine.

When auscultating the patient's heart, no pathological murmur or pericardial friction sound could be heard in the auscultation area of ​​each valve.

The heart should be normal.

It stands to reason that after this step of investigation, the patient can basically be transferred to other departments.

But Zhou Can didn't do that.

When people come to him specifically for diagnosis and treatment, even if they are just being polite, he will go all out.

To improve the reputation of cardiothoracic surgery, it needs continuous accumulation.

Zhou Can is also very interested in this difficult case.

He then auscultated the patient's abdomen and heard no obvious abnormal bowel sounds. He tried palpation with his hands and found that the abdomen was flat and soft. There was no obvious tenderness reaction in the entire abdomen, and no masses were found. There was no percussion pain in the liver and kidney areas.

After examining the chest and abdomen and finding no major findings, he also specifically checked the patient's spine and found no deformity.

No obvious lumbar disc herniation was found.

Considering that the patient had been walking too much when he was young, he had symptoms such as numbness and coldness in his legs. This made him unable to rule out the possibility that the patient's spine would become diseased and compress the nerves, causing the above symptoms.

After Zhou Can's pathological diagnosis was promoted to level six, he gained a deeper understanding and understanding of the nine major systems and three major cycles of the human body.

It used to be thought that the blood supply of the body was only directly related to blood vessels.

Now that his level has improved, he realizes that it was too superficial before. Nerves can also affect blood supply, and there are many other factors that can affect blood supply.

Such as heart failure, premature beats, etc.

After checking the upper body, Zhou Can focused on the patient's right leg again.

The fourth toe of the right foot turned black and showed gangrene changes. When the skin temperature of the right calf was touched, it was obviously much colder than that of the left calf.

This means that there is likely to be a problem with the blood circulation in the patient's right foot.

"I need to check the nerve reflexes of your feet to determine the cause of the disease. Just stay in a natural and relaxed state. It will not cause any damage to your body."

Zhou Can said to the patient.

"It's good. Finally, we have different examination items from other doctors."

The patient felt very happy after hearing this.

After so many doctors examined and treated him, all of them had no effect. He must be under great inner pressure.

When he felt almost desperate, a doctor suddenly came up with some new tricks, which gave him a glimmer of hope. So he was very happy.

"Come on, sit down with your legs naturally bent and vertical."

After Zhou Can asked the patient to sit down, he motioned to his family members to hold the patient in order to prevent him from falling and causing an accident.

The percussion hammer was struck against the patient's left knee.

Bang!

There was an obvious knee jerk reflex in the left leg. Trying the right leg again, the knee jerk reflex was also normal.
To be continued...